Student Name: RA …………………………………… Student Number: ………………………………….... Unit Topics: Work within a structured counselling framework; Support clients in decision making processes Unit Codes: CHCCSL501A; CHCCSL507B STUDY GUIDE 1 COUNSELLING AND THE COUNSELLING PROCESS Published by: Australian Institute of Professional Counsellors Pty Ltd ATF AIPC Trust ACN 077 738 035 All Case Histories in this text are presented as examples only and any comparison which might be made with persons either living or dead is purely coincidental. Fourth Edition, August 2015 Copyright ownership: Australian Institute of Professional Counsellors Pty Ltd ATF AIPC Trust ACN 077 738 035 This book is copyright protected under the Berne Convention. All rights reserved. No reproduction without permission. Australian Institute of Professional Counsellors Head Office 47 Baxter St., Fortitude Valley, QLD 4006. This book is protected by copyright and may not be reproduced or copied either in part or in whole nor used for financial gain without the express approval in writing of the owner (Australian Institute of Professional Counsellors Pty Ltd ATF AIPC Trust ACN 077 738 035) of the copyright Contents Unit Overview.................................................................................................................................................... 5 Assessment .................................................................................................................................................. 6 How to Use This Study Guide ............................................................................................................... 7 Unit Outcomes............................................................................................................................................ 8 INTRODUCTION ............................................................................................................................................. 13 SECTION 1 ........................................................................................................................................................ 15 INTRODUCTION TO COUNSELLING ....................................................................................................... 16 What is counselling? ............................................................................................................................... 16 The history of counselling .................................................................................................................... 17 Counselling vs. other helping professions ..................................................................................... 18 An introduction to counselling theories ......................................................................................... 19 An introduction to human life stage development .................................................................... 22 SECTION 2 ........................................................................................................................................................ 27 USING A STRUCTURED COUNSELLING PROCESS............................................................................. 28 The purpose of structuring .................................................................................................................. 28 The basic counselling structure .......................................................................................................... 29 Clarifying the client’s understanding and expectations ............................................................ 31 Supporting clients in decision-making processes....................................................................... 33 SECTION 3 ........................................................................................................................................................ 37 THE HELPING RELATIONSHIP ................................................................................................................... 38 Building rapport ....................................................................................................................................... 38 Microskills ................................................................................................................................................... 39 Obstacles to the counselling process .............................................................................................. 42 SECTION 4 ........................................................................................................................................................ 47 COUNSELLOR RESPONSIBILITIES ............................................................................................................ 48 Supervision................................................................................................................................................. 48 Counsellor responsibilities to clients ................................................................................................ 49 Counsellor responsibilities to their organisation ......................................................................... 55 3 Study Guide 1: Counselling and the Counselling Process READINGS A – G ............................................................................................................................................ 57 Reading A ................................................................................................................................................... 59 Reading B .................................................................................................................................................... 75 Reading C.................................................................................................................................................... 85 Reading D ................................................................................................................................................... 99 Reading E ................................................................................................................................................. 105 Reading F ................................................................................................................................................. 111 Reading G ................................................................................................................................................ 117 4 Unit Overview Unit Overview Unit Title CHCCSL501A – Work within a structured counselling framework. CHCCSL507B – Support clients in decision making processes Unit Purpose These two units describe the knowledge and skills required to work within an agency’s agreed counselling model, as well as support clients in planning a course of action. Prerequisites There are no pre-requisites for this unit. Content Introduction to counselling Structured counselling The helping relationship Counsellor responsibilities Resources/Readings Readings A – G are located at the end of this Study Guide. Suggested Hours Although everyone will work at their own pace, we suggest you allow approximately 100 hours to complete this unit competently, including seminars, tutorials, assignments and any practical activities. Time Frame The recommended time frame for Unit 1 – Counselling and the Counselling Process is 4 weeks. Please note that Austudy/Abstudy students must keep to the Austudy/Abstudy Assessment Due Dates on the Course Outline. Failure to do so may result in your benefit being revoked. Remember to notify the Institute of your Austudy/Abstudy acceptance. 5 Study Guide 1: Counselling and the Counselling Process Assessment This unit will be assessed by completing Assessment Book 1 and an additional Practical Assessment. You are required to complete all Assessment Book questions successfully including written assignments, case studies, research projects and exercises as required. You have several options for submitting your completed Assessment Book: Via the Online Resource Centre (ORC). You have been provided with your login to the ORC in your enrolment pack. You can also register to access the ORC at www.aipc.net.au by clicking on Students and then clicking on the ONLINE RESOURCE CENTRE button. Instructions are provided to guide you through completing your Assessment Book and submitting it for online marking. Use of the ORC will significantly reduce the time and cost involved in posting your Assessment Book for marking. This is the most efficient submission method. After registering, if you are unable to upload the document via the ORC, email the document as an attachment to education@aipc.net.au If you cannot access the assessment book, then type the answers to the questions in an editable Word document and email the document as an attachment to education@aipc.net.au. If you use this option, please include the unit title, Assessment Book edition – month and year (found on the inside cover of the Assessment Book), as well as your name and student number on the first page. You must also clearly label the section and question numbers for ALL your responses. Submissions that do not meet these guidelines will be returned unmarked. Completing a printed copy of your assessment book by hand. Please ensure you write clearly in either blue or black pen (no pencil please). Failure to submit clean, legible Assessment Books will unfortunately result in these being returned to you, unmarked. Should you need more space to complete questions, please attach another page to the relevant Assessment Book page and ensure any additions are clearly marked at the top of the page with: − your name − student number − the unit code and title − section number and title − the question number your additional page refers to Submit your completed Assessment Book by post to the address below: Address: The Australian Institute of Professional Counsellors Locked Bag 15 FORTITUDE VALLEY QLD 4006 If posting your Assessment Book, please take a copy (in case of loss in the mail) before posting it. Please be aware that although we endeavour to mark your work within 3 weeks of receiving it, you might not receive your books until a much later date due to the postal process involved. 6 Unit Overview How to Use This Study Guide This Study Guide contains all of the information that you need to complete the assessment tasks associated with this unit. You must read through all of the information provided (both the Study Guide and associated Readings) before attempting the assessment tasks. Throughout this Study Guide there are a few icons used to help you. These include: The Tip Icon This is used to indicate the presence of tips or additional instructions that may assist you as you work through this Study Guide. You will usually find them at the beginning of each Section of the Study Guide to indicate which Readings supplement the information provided in that Section. The Reading Icon You will find these throughout the Study Guide. They indicate that a particular Reading contains additional information on the topic that is being discussed at that point. Reading A The Reflect Icon This indicates a self-reflection question. You are not required to submit answers to these questions. They are designed to get you thinking more about the topic and to consider key points in order to aid your understanding. The Assessment Icon This is an assessment icon. It indicates the presence of assessment questions. Thank you for choosing to study with The Australian Institute of Professional Counsellors. Best Wishes! 7 Study Guide 1: Counselling and the Counselling Process Unit Outcomes Upon completion of this unit, you should be able to: Element CHCCSL501A/01 Use a structured approach to counselling Performance Criteria 1.1 Use initial session to gather information as a foundation for counselling process 1.2 Follow a structured approach to counselling work based on client needs and expectations 1.3 Explain counselling process to clarify client’s understanding and expectation CHCCSL501A/02 Establish the nature of the helping relationship 2.1 Enable clients to understand the nature of the counselling service on offer 2.2 Clarify, confirm or modify clients’ expectations of the counselling service 2.3 Identify any anxieties about the counselling process and explore with clients 2.4 Acknowledge and respect clients’ immediate concerns 2.5 Clarify both expectations and commitment to the counselling relationship and confirm with clients 2.6 Identify indicators of client issues requiring referral and report or refer appropriately, in line with organisation requirements 2.7 Develop a plan for counselling and contract with client as required to address disclosure and organisation/service requirements CHCCSL501A/03 Confirm the appropriateness of the helping relationship. 3.1 Ensure own level of skill and knowledge of counselling methods and resources are appropriate to meet client needs 3.2 Explore alternatives to the proposed relationship with clients where appropriate 3.3 Affirm significance of what the client says 3.4 Promote clients’ understanding of what they have a right to expect from the service 8 Unit Overview Element CHCCSL507B/01 Assist clients in clarifying their aims and requirements Performance Criteria 1.1 Clearly explain to clients the policy on record keeping and confidentiality 1.2 Encourage clients to identify and explore overall aims, requirements, and ideas for meeting them 1.3 Encourage clients to feel at ease and express themselves 1.4 Identify practical goals and requirements, and discuss with clients how these might be modified 1.5 Identify with clients potential courses of action for meeting individual aims and requirements 1.6 Where aims and requirements of clients cannot be met, refer clients to appropriate alternative sources of guidance and support 1.7 Identify indicators of client issues requiring referral and report or refer appropriately, in line with organisation requirements CHCCSL507B/02 Enable clients to explore possible courses of action 2.1 Explore with client factors which could influence the preference for and ability to achieve a course of action. 2.1 Explore with clients features of and likely consequences of possible courses of action. 2.3 Check client understanding of what is involved. 2.4 Help clients to assess advantages and disadvantages of each possible course of action, and their overall appropriateness for meeting particular client requirements. 2.5 Encourage clients to decide on a course of action and to consider alternatives which could be used if necessary. 2.6 Document decisions and agreed support within organisation guidelines ESSENTIAL KNOWLEDGE FOR CHCCSL501A The candidate must be able to demonstrate essential knowledge required to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role. 9 Study Guide 1: Counselling and the Counselling Process These include knowledge of: Background knowledge of the counselling process including: purpose of counselling how counselling has evolved as a helping relationship place of counselling within the helping services scope of counselling relationship, including professional limitations Ethical responsibilities in providing counselling Rights of clients involved in counselling Counselling context, process and goals Knowledge of theories supporting the counselling process Human Life Stage development ESSENTIAL SKILLS FOR CHCCSL501A To achieve the performance criteria, the following skills are required. These include the ability to: Work within the counselling framework Manage own values so they do not impede effective work and managing stress of the work Develop empathy and rapport Demonstrate application of skills in - Active listening - Respectful responding - Well timed challenging - Attention to counselling relationship - Contracting appropriate to context RANGE STATEMENT FOR CHCCSL501A Nature of the counselling service: Context and resources of agency Preferred counselling model/s of agency Counselling methods: Are according to agency policy and procedures Client issues requiring referral may include, but are not limited to: Child protection issues Suicide prevention/intervention Domestic and family violence Mental health issues Alcohol and other drugs issues ESSENTIAL KNOWLEDGE FOR CHCCSL507B The candidate must be able to demonstrate essential knowledge required to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role. These include knowledge of: Referral protocols Necessary self awareness including: 10 Unit Overview - Role within the organisation - Limits of competence and responsibility - Personal strengths and limitations - Individual needs for support and supervision - Capacity to be non-judgemental and/or difficulty with this Agency/organisation model/s of counselling and intervention Indication of physical or mental ill health Key and major psychology theories Obstacles to counselling process Human life stage development Policy and principles and procedures to secure and maintain confidentiality including note-taking, record and log keeping and identity protection Relevant legislation and ethical code of practice Development of a range of possible interventions ESSENTIAL SKILLS FOR CHCCSL507B It is critical the candidate demonstrate the ability to: Work within the counselling framework. Managing own values so they do not impede effective work and managing stress of the work Demonstrate application of skills in: - Problem solving - Counselling processes and methods - Respect for client strengths or particular needs - Capacity to maintain and critique realistic limits for agency service and client expectations. Maintain documentation as required, including effective use of relevant information technology in line with work and safety (WHS) guidelines. RANGE STATEMENT FOR CHCCSL507B Referral may include to specialist services/agencies such as: Medical Psychiatric Grief and Loss Various compulsions (such as gambling) Financial counselling Client issue requiring referral may include, but are not limited to: Child protection issues Suicide prevention/intervention Domestic and family violence Mental health issues Alcohol and other drugs issues 11 Study Guide 1: Counselling and the Counselling Process 12 INTRODUCTION 13 Study Guide 1: Counselling and the Counselling Process Introduction About this Unit: This unit is designed to provide you with an introduction to counselling. The counselling process you will learn in this unit offers a framework from which you can structure your own counselling sessions and may assist you in later units when you study more specific counselling strategies and approaches. Overview of Sections: Section 1: Introduction to counselling In the initial section of this Study Guide you will be introduced to the profession of counselling. You will learn about the purpose of counselling and how counselling has evolved as a helping profession. You will also be introduced to several of the major counselling theories and approaches that will be expanded upon later in the course. Section 2: Using a structured counselling process This section explains the need to structure the counselling process so that the counsellor and client work through specific phases to reach their desired outcomes. You will be introduced to one general counselling structure and a counselling structure that can be used for problem solving. You will also learn how to discuss structuring with clients and confirm the client’s commitment using a counselling contract. Section 3: The helping relationship This section introduces you to the importance of the counselling or helping relationship. You will learn about developing rapport with your client using microskills, as well as some of the obstacles that may occur during the counselling process. Section 4: Counsellor responsibilities Counsellors must always be mindful of their responsibilities and meeting the client’s needs. This section explores key issues that counsellors must be aware of, such as client rights within the counselling process and ensuring that the counsellor’s level of skill and knowledge of counselling methods is appropriate for the task at hand. Issues of referral will also be explored. Important note: Readings A – G are located at the end of this Study Guide. Important note to students: The Readings contained in this Study Guide are a collection of extracts from various books, articles and other publications. The Readings have been replicated exactly from their original source, meaning that any errors in the original document will be transferred into this Study Guide. In addition, if a Reading originates from an American source, it will maintain its American spelling and terminology. The Australian Institute of Professional Counsellors is committed to providing you with high quality study materials and trusts that you will find these Readings beneficial and enjoyable. 14 Section 1 INTRODUCTION TO COUNSELLING 15 Study Guide 1: Counselling and the counselling process Introduction to Counselling About this Section: In this section you will learn about: − The purpose of counselling − The history of counselling and how it has evolved as a helping profession − The place of counselling among the helping professions − The theoretical influences on counselling − The major counselling approaches Supporting materials: The following materials supplement the information provided in this section: 1. Reading A Welcome to your Diploma of Counselling! Throughout this course, you will be introduced to the world of counselling, including the many different approaches and skills that will assist you in your practice. Before we delve too deeply into what counselling involves, it is useful to have a basic understanding of the theoretical roots of counselling and therapy. This section will provide you with a brief overview of the development of counselling as a profession, as well as some of the major counselling theories. While you are working your way through this Study Guide, it is important to remember that the information provided in this introductory unit is simply a brief overview. You will learn much more about specific counselling skills and approaches as you progress throughout the course. The goal at this stage is to lay the groundwork on which you will continue to build your skills and knowledge, both throughout this course and onwards throughout your career. You will also notice a number of self-reflection questions included within the Study Guides of this course. They are provided to assist you with thinking about the material you are learning and do not require a written response. Simply take a few minutes to reflect upon your learning. The ability to reflect is vital for a counsellor. What is counselling? “Counselling is fundamentally based on conversation, on the capacity of people to 'talk things through' and to generate new possibilities for action through dialogue.” (McLeod, 2013, p. 8) Reading A The basic purpose of counselling is to provide a client with a confidential, safe and supportive environment where they can tell their story, work through their emotions, and make positive changes to their life. The role of the counsellor is to facilitate the client’s self-development by providing the client with an opportunity to gain a better understanding of who they are, where they want to be, and how to get there. The counsellor supports the client to achieve their goals and gain greater insight into their lives. Furthermore, effective counsellors assist clients to build skills that they can use to solve other difficulties in their lives For example, if a client 16 Section 1: Introduction to counselling learns good communication skills to help resolve a problem with their spouse, they will also be able to use those communication skills with their children, friends, or co-workers. Self-reflection What does the term ‘counselling’ mean to you? What ideas or notions about the purpose of counselling or the role of a counsellor do you currently have? Consider the various definitions of counselling that are presented in Reading A. Which of these do you identity with most? Why? The history of counselling The origins of counselling can be traced back to the beginning of the eighteenth century when the industrial revolution brought large-scale changes to society. Before that time, people lived in small rural communities and the head of the local church would usually deal with emotional and interpersonal problems. People with more serious mental disturbances were tolerated and even cared for by the community. However, after the community fragmentation that resulted from the industrial revolution, there was a shift towards placing people with a mental illness into asylums. The medical profession took control of these asylums, and towards the end of the nineteenth century, the medical specialisation of psychiatry emerged (psychiatry is the science of treating mental diseases). It was from this new field of medicine that psychotherapy evolved. Counselling shares some of the philosophies and methods of psychotherapy, but, as the extract below illustrates, it has stronger connections to social reform and a strong presence in the voluntary sector. “The history of psychotherapy has been much more fully documented than the history of counselling. Counselling as a distinct profession came of age only in the 1940s. One of the public markers of the emergence of counselling at that time was that Carl Rogers, in the face of opposition from the medical profession to the idea that anyone without medical training could call himself a ‘psychotherapist’, began to use the term ‘counselling and psychotherapy’ to describe his approach (Rogers, 1942). Although in many respects counselling, both then and now, can be seen as an extension of psychotherapy, a parallel activity or even a means of ‘marketing’ psychotherapy to new groups of consumers, there are also at least two important historical strands that differentiate counselling from psychotherapy: involvement in the educational system and the role of the voluntary sector. The American Personnel and Guidance Association, which was later to become the American Counselling Association was formed in 1952, through the merger of a number of vocational guidance professional groups that were already well established by that time. The membership of the American Personnel and Guidance Association consisted of counsellors who worked in schools, colleges, and career advisory services. In Britain, the Standing Council for the Advancement of Counselling, which was later to become the British Association for Counselling was inaugurated in 1971, by a network of people who were primarily based in social services, social work and the voluntary sector. The precursors to the formation of these organizations can be understood in terms of a sense of crisis within society, or ‘moral panic’, around various areas of social life. In effect, what happened was that there was a sense of unease around some aspect of the breakdown of social order, or the identification of groups of individuals who were being unfairly treated in some way. These crises were characterized by widespread publicity about the problem, debate in newspapers and magazines, and efforts to bring about political or legislative change. At some 17 Reading A Study Guide 1: Counselling and the Counselling Process point in this process, someone would have the idea that the best means of helping was to treat each person needing assistance as an individual, and that the most effective way to proceed was to sit down with that individual, discuss the matter, and find the best way forward for that person in terms of his or her unique needs and circumstances. The idea of ‘counselling’ appears to have emerged more or less simultaneously, in many different fields of social action, in this manner.” (McLeod, 2013, pp. 31-32) From the extract (and the remainder of Reading A), we can see that while counselling has connections to the psychotherapeutic approach that arose out of medicine/psychiatry, counselling as we know it today has broader social origins. Modern counselling: Has a strong footing in social services Arose as a form of social action Sees individuals as having unique needs and circumstances Has a connection with righting injustice Views client problems and issues within their social context Has a collaborative focus There has also been a proliferation of different counselling approaches, including cognitivebehavioural therapy, person-centred therapy, gestalt therapy, solution focused therapy and narrative therapy (which you will learn about in detail later in this course). Counselling vs. other helping professions There are several key similarities and differences between counsellors and other types of helping professionals. Counsellors assist people to identify and define their emotional issues and better understand themselves by explaining options, setting goals, providing therapy, and helping them to take action. Psychologists study human behaviour and the processes involved in how people think and feel. They conduct research and provide treatment and counselling in order to reduce distress and behavioural and psychological problems, and promote mental health and positive behaviour in individuals and groups. Psychologists work on a broad range of issues with clients, including children, adults, couples, families, and organisations. Social workers help people to deal with personal and social problems, either directly or by planning or carrying out programmes that benefit groups or communities. Psychiatrists diagnose, treat and try to prevent human mental, emotional, and behavioural disorders. Unlike counsellors, psychologists, and social workers, psychiatrists have a medical degree and the authority to prescribe medicines. (Adapted from Myfuture, 2013) Each of the professions listed above have distinct duties, however, there can be significant overlap. For example, psychologists, social workers, and psychiatrists can draw upon counselling principles and techniques within their work. Despite their differences, all four professions are committed to improving people’s physical, social, and emotional quality of life. 18 Section 1: Introduction to counselling Self-reflection Are there any other key differences between counsellors and other helping professions that you can identify? What do you think is the most important difference that separates counsellors from the other helping proffesionals? Why do you think that is important? An introduction to counselling theories There are many different types, approaches, and theories of counselling and therapy. Some counsellors only practice one type of counselling (e.g., cognitive behavioural therapy or person-centred therapy); whilst others use a variety of techniques taken from a range of approaches. This is known as taking an “eclectic” approach. As you grow and develop your counselling skills, you may find yourself developing a preference for a particular style of counselling or you may change your approach depending upon the client and their needs. All counselling approaches are built on theoretical foundations that help to explain how and why a person has become who they are and how they can make changes to their lives. Before learning about the different styles of counselling, it is helpful to understand the theoretical foundations that have influenced counselling and shaped these approaches. Why are counselling theories important? A common question at this stage of a counsellor’s development is: “Why are counselling theories important?” The answer to this question is that theories provide counsellors with a framework from which to work. As Nelson-Jones (2014) explains, counsellors are decision makers – as a counsellor, you will be constantly making choices about how to think about your client’s behaviour and how to respond. Understanding the various counselling theories will provide you with a range of concepts that you can draw from in order to think systematically about human development and behaviour as well as provide you with a framework from which to inform your interventions and approach with individual clients. We will now outline some of the major theories that inform specific counselling approaches. Please note, these are just brief overviews of the different theories. You will learn more about them in future units of this course. 1. Psychoanalytic theory Psychoanalytic theory was introduced around the turn of the 20th century by Sigmund Freud. Freud contributed much to the field, including his beliefs about the unconscious, the role of child development and memories, and defence mechanisms (Kottler & Shepard, 2015). Freud believed that people’s problems could be alleviated by bringing unconscious material into consciousness and having people experience their repressed memories and emotions. The most important concepts within Freud’s work and psychoanalytic theory include: The role of the unconscious The structure of personality The psychosexual stages of development The importance of the past and childhood experience The use of ego defence mechanisms Transference and the nature of the therapeutic relationship The significance of dreams Free association, or the ‘talking cure’ 19 Study Guide 1: Counselling and the Counselling Process Interpretation (Hough, 2014, p. 77) Other prolific theorists within psychoanalytic theory include Carl Jung, Alfred Adler, and Erik Erikson (Kottler & Shepard, 2015). By today’s standards, many of these theorists and their concepts are now considered controversial; however, their contribution to the profession of counselling is important. Note: You will learn more about Freud in Study Guide 4 – Personality and Development Theories. 2. Cognitive/behavioural theory The current cognitive behavioural approach to counselling is an amalgamation of two theoretical orientations, the behavioural and the cognitive approaches: Behavioural therapy Behavioural therapy stems from the theoretical concept of behaviourism – the “scientific study of behaviour based on observable actions and reactions” (Hough, 2014, p. 240). Behaviourists believe in the importance of the interaction between human behaviour and the environment. Theorists such as Ivan Pavlov and B. F. Skinner used their work with animals to show that humans are “conditioned” by their environments to behave in certain ways. Behaviour modification is used to assist clients in changing their behaviours. Note: These theories will be discussed in more detail in Study Guide 5 – Learning Theories. Cognitive therapy Cognition refers to the “experience of thinking, reasoning, perceiving, and remembering” (Hough, 2014, p. 238), therefore, cognitive therapy is concerned with a person’s thinking and reasoning. Cognitive theorists are different to behaviourists in that they consider “problems to arise not directly from events themselves but from how the individual interprets and creates meaning from them” (Milne, 2010, p. 192). Cognitive therapy uses cognitive restructuring to help clients change their faulty or destructive thinking processes (Hough, 2014). Prolific cognitive therapists include Aaron Beck and Albert Ellis. Cognitive behavioural therapy Known as CBT, cognitive behavioural therapy combines behaviour modification from behavioural therapy with cognitive restructuring from cognitive therapy (Pennington, 2013). CBT practitioners believe that thoughts, feelings, and behaviours are interrelated (Barkway, 2013). The goal of CBT is to help the client uncover and alter distortions in their thinking which cause psychological distress. CBT is one of the most widely used approaches today. Note: Cognitive behavioural therapy will be discussed in more detail in Study Guide 6 – Cognitive Behavioural Therapy. 3. Humanistic Before the 1950s, counselling and therapy was dominated by psychoanalysis and behaviourist theories (McLeod, 2013). Humanistic theory emerged during the 1950s as an alternative to these approaches. The humanistic school of thought focuses on the uniqueness and innate worth of each individual and the capacity of humans to grow and reach their full potential. Humanistic theory postulates: 1. Human beings, as human, supersede the sum of their parts. They cannot be reduced to components. 2. Human beings have their existence in a uniquely human context, as well as in cosmic ecology. 20 Section 1: Introduction to counselling 3. Human beings are aware and aware of being aware – i.e., they are conscious. Human consciousness always includes an awareness of oneself in the context of other people. 4. Human beings have some choice and, with that, responsibility. 5. Human beings are intentional, aim at goals, are aware that they cause future events, and seek meaning, value and creativity. (McLeod, 2013, pp. 166-167) Influential to the field of humanstic theory were Carl Rogers and Abraham Maslow. Maslow developed the hierachy of needs model (see diagram below) that suggests that lower-level needs (those at the bottom of the triangle) must be satisfied before higher-level needs can be met (Nevid, 2013). Self-actualisation (the fulfilment of one’s full potential) can only occur once the needs in the first four levels of the triangle have been met. Rogers is credited with the development of person-centred (or ‘client-centred’) counselling. He identified three core conditions that are necessary for clients to make progress: empathy, unconditional positive regard, and congruence or genuineness (Hough, 2014). The basic theory of person-centred counselling suggests that if the counsellor is successful in conveying genuineness, unconditional positive regard, and empathy, then the client will respond with constructive changes (Wedding & Corsini, 2014). Note: Person-centred therapy is discussed further in Study Guide 7 – Person-Centred Therapy. 21 Study Guide 1: Counselling and the Counselling Process 4. Postmodern approaches A number of other counselling approaches have emerged from the late 20th century onwards. In what are known as “postmodern” versions of counselling, counsellors focus on deconstructing beliefs and examining their value within an individual’s life. “The postmodern mindset argues for the acceptance of multiple culturally determined realities, all of equal validity. Postmodern/constructivist therapists endeavour to help clients rewrite their personal narratives and to reframe their lives” (Jones-Smith, 2012, p. 291) Postmodern approaches come from a strengths-based perspective and help to empower the client rather than focusing on problems and deficits. The two postmodern approaches that you will learn about in this course are narrative and solution-focused therapy. Solution-focused therapy According to Corey (2013, p. 400), solution-focused therapy is “a future-focused, goaloriented therapeutic approach” that focuses on client strengths and encourages clients to consider what their preferred future would look like. It is the counsellor’s job to help clients identify their strengths and past successes and work towards their goals and preferred future. Note: Solution focused therapy is discussed in more detail in Study Guide 9 – Solution Focused Therapy. Narrative therapy In narrative therapy, counsellors help clients to separate themselves from their problems and view their lives from a different perspective (Kottler & Shepard, 2015). There are several central premises to narrative therapy: 1. The meaning people give to their lives is shaped by the stories they tell themselves; 2. These stories can constrict their lives and are often influenced by the dominant culture in which they live; 3. The proper focus of counselling should be helping people examine and “re-author” their stories. (Kottler & Shepard, 2015, p. 139) Note: Narrative therapy is discussed in more detail in Study Guide 10 – Narrative Therapy. An introduction to human life stage development Other theories that have strongly influenced counselling practice relate to human development and change across the lifespan. According to Zastrow and Kirst-Ashman (2013), understanding of human development helps counsellors to know what behaviours are “normal” or appropriate and what are not. Additionally, many of the issues that clients bring to counselling are a result of changes across the lifespan. By considering theories of lifespan development, counsellors can have a better understanding of the various difficulties clients face at different points in their lives. We will briefly explore three key developmental theories over the following pages. 1. Freud’s Psychosexual Stages In addition to the concepts discussed earlier in this section, Freud also had an important influence on the understanding of human development. While revolutionary at the time, Freud’s theories about the psychosexual stages of development are considered controversial 22 Section 1: Introduction to counselling in counselling today. However, it is important to know about them and understand how the field of counselling has been affected by developmental theories. The following table outlines the stages that Freud believes humans go through. Freud’s Psychosexual Stages Psychosexual Period of Stage Development Oral Description Birth-1 year The new ego directs the baby’s sucking activities toward breast or bottle. If oral needs are not met appropriately, the individual may develop habits such as thumb sucking, fingernail biting, and pencil chewing in childhood and overeating and smoking in later life Anal 1-3 years Toddlers and preschoolers enjoy holding and releasing urine and faeces. Toilet training becomes a major issue between parent and child. If parents insist that children be trained before they are ready, or if they make too few demands, conflicts about anal control may appear in the form of extreme orderliness and cleanliness or messiness and disorder. Phallic 3-6 years As preschoolers take pleasure in genital stimulation, Freud’s Oedipus conflict for boys and Electra conflict for girls arise. Children feel a sexual desire for the other sex parent. To avoid punishment, they give up this desire and adopt the same sex parent’s characteristics and values. As a result, the superego is formed, and children feel guilty each time they violate its standards. Latency 6-11 years Sexual instincts die down, and the superego develops further. The child acquires new social values from adults and same sex peers outside the family. Genital Adolescence With puberty, the sexual impulses of the phallic stage reappear. If development has been successful during earlier stages, it leads to marriage, mature sexuality, and the birth and rearing of children. This stage extends through adulthood. Source: Adapted from Berk (2014, p. 16) Self-reflection Freud’s psychosexual stage theory is often reflected in mainstream ‘pop-psychology’. Have you ever heard of someone being referred to as “anal” because they are a very tiny or ordered individual? What about someone saying that they have an “oral fixation”? Have you previously heard of the Oedipus or Electra complex? Take some time to re-read the above table – can you see where these expressions have come from? 2. Erikson’s Psychosocial Stages According to Erikson, our personalities are a result of the interaction between our biologically determined maturation and the demands placed upon us by society (Zastrow & Kirst-Ashman, 2013). The degree to which we resolve these demands at each stage will influence our ability to resolve demands at later stages. Erikson’s stages are based partly on Freud’s stages, however, 23 Study Guide 1: Counselling and the Counselling Process unlike Freud, Erikson extended his theory across the lifespan (Hough, 2014). The table below outlines Erikson’s psychosocial stages. Erikson’s Psychosocial Stages Psychosocial Period of Stage Development Basis trust vs. mistrust (oral) Birth-1 year Autonomy vs. shame and doubt (anal) 1-3 years Generativity vs. stagnation Middle adulthood Description From warm, responsive care, infants gain a sense of trust, or confidence, that the world is good. Mistrust occurs when infants have to wait too long for comfort and are handled harshly. Using new mental and motor skills, children want to choose and decide for themselves. Autonomy is fostered when parents permit reasonable free choice and do not force or shame the child. 3-6 years Initiative vs. Through make-believe play, children explore the kind of guilt (phallic) person they can become. Initiative – a sense of ambition and responsibility develops when parents support their child’s new sense of purpose. When parents demand too much self control, they induce excessive guilt. 6-11 years Industry vs. At school, children develop the capacity to work and Inferiority cooperate with others. Inferiority develops when (genital) negative experiences at home, at school, or with peers lead to feelings of incompetence. Adolescence Identity vs. The adolescent tries to answer the question, who am I, role confusion and what is my place in society? By exploring values and (genital) vocational goals, the young person forms a personal identity. The negative outcome is confusion about future adult roles. Early adulthood Young adults work on establishing intimate ties to Intimacy vs. isolation others. Because of earlier disappointments, some individuals cannot form close relationships and remain isolated. Generativity means giving to the next generation through child rearing, caring for others, or productive work. The person who fails in these ways feels an absence of meaningful accomplishment. Late adulthood Elders reflect on the kind of person they have been. Ego integrity vs. despair Integrity results from feeling that life was worth living as it happened. Those who are dissatisfied with their lives fear death. Source: Adapted from Berk (2014, p. 16) Self-reflection Look back over your life in the context of these stages. Can you relate to the challenges noted in the above table? 24 Section 1: Introduction to counselling 3. Piaget’s Stages of Cognitive Development Through observations of his own children’s growth, Jean Piaget proposed that children go through several stages of learning in order to develop how to think (Zastrow & Kirst-Ashman, 2013). Thinking becomes more complex and complicated as the person gets older (Zastrow & Kirst-Ashman, 2013). The table on the following page outlines these stages. Piaget’s Stages of Cognitive Development Stage Period of Development Sensorimotor Description Birth-2 years Infants “think” by acting on the world with their eyes, ears, hands, and mouth. As a result, they invent ways of solving simple problems, such as pulling a lever to hear the sound of a music box, finding hidden toys, and putting them in and taking them out of containers. Preoperational 2-7 years Preschool children use symbols to represent their earlier sensorimotor discoveries. Development of language and make-believe play takes place. However, thinking lacks the logic of the two remaining stages. 7-11 years Concrete Children’s reasoning becomes logical. School age operational children understand that a certain amount of lemonade or play dough remains the same even after its appearance changes. They also organise objects into hierarchies of classes and subclasses. However, thinking falls short of adult intelligence. It is not yet abstract Formal 11 years The capacity for abstract, systematic thinking enables operation onwards adolescents when faced with a problem, to start with a hypothesis, deduce testable inferences, and isolate and combine variables to see which inferences are confirmed. Adolescents can also evaluate the logic of verbal statements without referring to real-world circumstances. Source: Adapted from Berk (2014, p. 19) Note: You will learn more about these theories of development in Study Guide 4 – Personality and Development Theories. Summary This section of the Study Guide introduced you to the counselling profession. It provided you with an overview of the evolution of counselling and its current place within the helping professions. You were also introduced to some of the major counselling theories that you will learn about later in the course. References Barkway, P. (2013). Psychology for health professionals (2nd ed.). Chatswood, NSW: Elsevier. Berk, L. (2014). Development through the lifespan (6th ed.). New York, NY: Pearson. Corey, G. (2013). Theory and practice of counseling and psychotherapy (9th ed.). Belmont, CA: Brooks/Cole. 25 Study Guide 1: Counselling and the Counselling Process Hough, M. (2014). Counselling skills and theory (4th ed.). London, UK: Hodder Education. Jones-Smith, E. (2012). Theories of counseling and psychotherapy: An integrative approach. Thousand Oaks, CA: Sage. Kottler, J. A., & Shepard, D. S. (2015). Introduction to counseling: Voices from the field (8th ed.). Stamford, CT: Cengage Learning. McLeod, J. (2013). An introduction to counselling (5th ed.). London, UK: Open University Press. Milne, A. (2010). Understand counselling: Teach yourself. London, UK: Hodder Education. Myfuture (2013). Retrieved from http://www.myfuture.edu.au/ Nelson-Jones, R. (2014). Practical counselling and helping skills: Texts and activities for the lifeskills counselling model (6th ed.). Dorchester, UK: Sage Publications. Nevid, J. S. (2013). Psychology: Concepts and applications (4th ed.). Belmont, CA: Wadsworth. Pennington, A. (2013). The student guide to counselling and psychotherapy approaches. London, UK: Sage. Wedding, D., & Corsini, R. J. (2014). Current psychotherapies (10th ed.). Belmont, CA: Brooks/Cole, Cengage Learning. Zastrow, C. H., & Kirst-Ashman, K. K. (2013). Understanding human behavior and the social environment (9th ed.). Belmont, CA: Brooks/Cole. Assessment activities Assessment activities relevant to this section of the Study Guide are contained in Section 1 of your Assessment Book. 26 Section 2 USING A STRUCTURED COUNSELLING PROCESS 27 Study Guide 1: Counselling and the counselling process Using a Structured Counselling Process About this Section: In this section you will learn to: Work within a counselling framework Assist clients in clarifying their aims and requirements Develop and follow a structured approach to counselling based upon the client’s needs and expectations Enable clients to explore possible courses of action Use problem solving steps Enable clients to understand the nature of the counselling service on offer, and clarify their expectations and commitment to the counselling relationship Contract appropriate to context to address disclosure and organisation/service requirements Supporting materials: The following materials supplement the information provided in this section: 1. Reading B 2. Reading C This section of the Study Guide will introduce you to the counselling process. The counselling process includes everything from the moment the client initiates contact with a counselling service to the termination of the service. This can occur over a number of days, weeks, months, or even years, depending upon the client’s needs. The purpose of this section of the Study Guide is to help you to develop a basic understanding of what counselling involves and how counsellors may work with clients to meet their goals. As you will have noticed while reading about the different counselling approaches in the previous section of this Study Guide, there is no one set way in which to conduct counselling. As such, it is important for counsellors to take the time to explore with the client how counselling will proceed in each individual case. The purpose of structuring “Cormier et al. (2013) observe that ‘structuring’ refers to an interactional process between counsellors and clients in which they arrive at similar perceptions of the role of the counsellor, an understanding of what occurs in counselling, and an agreement on which outcome goals will be achieved. Structuring occurs throughout counselling, and even prior to counselling – for example, through the publicity, image and reputation of counsellors and counselling agencies.” (Nelson-Jones, 2014, p.130) It is important to structure the counselling process from the very first session. As a counsellor, this involves talking with the client and explaining your approach to counselling, the role of both the client and counsellor in your approach, how counselling would proceed, the client’s goals for counselling, what strategies or interventions you might use, the legal and ethical limits 28 Section 2: Using a structured counselling process of confidentiality, and more practical concerns such as the costs involved in sessions and how payment must be made. As Nelson-Jones (2014), outlines, structuring counselling can help to: Reduce anxiety by clarifying the role of the counsellor and client Explain the purpose of the current and subsequent sessions Establish the expectancy that clients will work on problems in addition to talking about them Establish the possibility of change for the client Communicate the limitations of the counselling relationship Developing a structured plan for counselling can also help to guide the process so that clients move through a set of distinct phases and reach a desired outcome. There are many different ways in which a plan for counselling can be developed, and thus, as a counsellor you may be asked to develop a range of possible interventions. In most cases, a counsellor will have a particular or preferred structure in mind when they meet with a new client. However, as counselling is a collaborative or interactional process, it is important that counsellors discuss the plan with the client and give them the opportunity to voice their opinions and concerns. Structured plans or frameworks are helpful for enabling both the client and counsellor to stay on track and for empowering the client to be a more active participant in achieving their goals. Self-reflection Imagine that you are a client who is entering a counselling session for the very first time. How would you feel if you knew very little about counselling and was unsure of what to expect? How do you think you would feel after the counsellor engaged in a structuring conversation with you? The basic counselling structure While counsellors from different theoretical orientations will have different approaches to the change process, most forms of counselling will follow the same basic structure that includes a preparatory, beginning, middle, and ending phase. “The assumption is made that, irrespective of theoretical orientation, it is possible to conceptualize the therapeutic process in terms of a framework of broadly defined phases or stages. Each phase is characterized by particular process goals or tasks that need to be achieved as a prerequisite of moving forward to the next phase (Beitman, 1990; Egan, 2010; McLeod, 2003). As a structural overview of the developmental process, the framework provides therapists with a sense of grounding and direction. But it is only a cognitive map and as such cannot reflect the actual experience or dynamics of a process that seldom, if ever, follows a straightforward linear progression through discrete and clearly defined phases. As the relationship between therapist and client develops, new issues may emerge, goals are evaluated and often redefined, and earlier phase-related tasks may be revisited and worked on more deeply. It is a fluid, multidimensional and complex process.” (Horton, 2012, p. 122) Self-reflection What benefits do you think there may be in the explicit structuring of the counselling process? What limitations do you think there may be in the explicit structuring of the counselling process? 29 Reading B Study Guide 1: Counselling and the counselling process The four basic phases that counselling progresses through are outlined in the following table. The four phases of counselling Phase Goals/tasks of the phase Preparatory Phase Revision of prior knowledge of the client (such as a referral letter or report). Introductory leaflet given to the client. The first telephone call between counsellor and client. Letter of appointment. Beginning Phase Build the relationship, establish rapport and an effective working alliance, clarify boundaries, conditions and the client’s role, and work towards developing mutual aims about the work of therapy. Facilitate client self-disclosure; identify the client’s presenting problem through understanding the client’s worldview and experiences, exploring antecedents, precipitating events, social/cultural context and assessment of client strengths and resources. The therapist may begin to develop a tentative assessment of the nature, origins and ramifications of the client’s problem(s) in a way that suggests a possible target for change. In some psychodynamic work the early fostering of a positive transference might be a key task. Negotiate therapeutic and business contracts, and monitor and review progress. Middle Phase Typically the longest phase in counselling; dependent upon the therapist’s theoretical orientation and how they explain the origin and maintenance of psychological problems and the principles of change. Conflicts and problems are more clearly defined and worked through. Therapist is concerned with facilitating learning and change. Process goals may involve searching for patterns and key themes in the client’s experiences and behaviours, affirming and, where possible and appropriate, using the client’s strengths and ways of coping, working towards new perspectives, deeper self-awareness or understanding and learning different ways of thinking, feeling, and/or behaving. May contain regular review sessions Ending Phase Seek resolution of the client’s issues around ending Explore ways of consolidating learning and change through helping clients to apply and assimilate change into new ways of being or living and through identifying obstacles and ways of sustaining and expanding change. Evaluating the outcomes of therapy and the effectiveness (or otherwise) of the therapeutic process and relationship. Source: Adapted from Horton (2012, pp. 122-127) For a more detailed description of these phases, please see Reading B. As the extract on the previous page illustrates, these stages are not set in stone and may change depending upon the Reading B 30 Section 2: Using a structured counselling process needs of your client. Therefore, it is important that as a counsellor you remain flexible, patient, and willing to adapt the structure of counselling in accordance with the client’s needs. It is also important to note that while you may have a preferred method and structure in mind, you will ultimately be guided by the organisation that you work for. Many organisations have preferred methods and you may be limited by the kinds of services they are equipped to provide. For example, while you may prefer to spend twenty sessions with a client, your organisation may be time limited and only allow six sessions. It is good practice to inform the client of all of these factors before you begin in order to clarify their expectations and understanding of the counselling process and the services offered by your organisation. Clarifying the client’s understanding and expectations Clients may come to counselling with very little idea of what counselling involves or what a particular service offers. Therefore, it is important that counsellors explain to clients during the initial session what their individual approach is and the nature of the counselling service on offer, including any limitations. If the client has a specific need that the counsellor (or their agency/organisation) cannot help with, or if the client has a specific problem that the counsellor’s individual approach may not be suitable for, then referral can be offered with minimal wasted time for both the client and counsellor (Ivey, Ivey & Zalaquett, 2014). It is important for counsellors to ensure that clients have an understanding of what resources and services the counselling relationship can offer before counselling begins. For example, a client who assumes that a counsellor can help them find accommodation or receive government assistance should be informed as soon as possible if this is not part of the service. Counsellors need to ensure that the client understands what the counselling service can and cannot offer from the outset. Similarly, counsellors should explain what models of counselling that they and their agency/organisation offer. A client may have worked with other counsellors or seen an example of counselling and assume all counsellors work in the same way. For example, a client may like the idea of a particular kind of counselling, such as cognitive behavioural therapy, and want to work in this way. However, if a counsellor and their agency/organisation only work from a person-centred approach, then the counsellor would need to explain this method to the client so that they have an understanding of what is involved and can decide whether they would be happy with this service. If the client prefers another counselling approach or the counsellor feels that the current service is not appropriate for the client’s particular needs, the counsellor should offer to refer the client to a more appropriate counsellor/service. Referral will be discussed in Section 4 of this Study Guide. Contracts Counselling contracts can be used as a way of formalising the plan and ensuring that both client and counsellor agree on what the counselling process will entail (including the type of treatment and the amount and frequency of sessions) and how outcomes will be achieved. Contracting can also be a way to help the client to develop realistic expectations of the counselling process and allow them to understand what is expected of them (i.e., attendance at appointments, payment, etc.). Contracts should be written within the context of the client’s needs, your abilities, and the organisation you are working for. You will need to make clear what services you/your organisation offers, including the limits to the service. “A counseling contract may include an agreement regarding issues such as those related to confidentiality, general and specific goals, the counseling process, the counseling methods to be used by the counselor, and issues to be discussed. At the contracting stage we like to make it clear that the client’s wishes will be respected with regard to what issues will and will not be 31 Study Guide 1: Counselling and the counselling process discussed. This is very important for some clients who may fear that they will be pressured in subtle ways to discuss issues which they do not wish to explore. Sometimes a contract will involve an agreement to attend counseling sessions at regular intervals; for example weekly or fortnightly for a particular number of sessions, with a review of the counselling process occurring at set times.” (Geldard & Geldard, 2012, p. 15) As the above extract illustrates, the counsellor should also discuss confidentiality and disclosure issues with the client as part of the counselling contract. Clients should be made aware of the circumstances under which confidentiality may be broken. Generally, these circumstances include: If the client discloses that they may harm themselves; If the client discloses that they may harm others, or; If the client’s file is subpoenaed by a court of law; or If the client has provided written permission for you to do so. A counselling contract may be a verbal or written agreement between the counsellor and the client (although written agreements are preferred for record-keeping purposes). The contract helps to establish the purpose of the service and outlines the methods the counsellor or agency use as well as the available resources of the agency. An example of a counselling contract is included below: COUNSELLING CONTRACT XYZ Counselling Service Counselling approach I believe that my clients have the desire and the capacity to grow towards fulfilling their true potential, and that they are the experts on their own lives. Therefore, I will not give you advice or offer solutions, but will work with you to help you understand yourself more fully and to find your own inner resources. With greater self-awareness and trust in yourself, I hope that you will be able to make constructive changes, leading to a more satisfying and meaningful life. Confidentiality Everything you share with me in the course of our work together will be treated as highly confidential. However, there are a few circumstances in which I may be required to break confidentiality: If I consider you to be at risk of seriously harming yourself or someone else If your counselling records have been requested by a court of law If another party or agency has requested your information, and you have agreed and provided your written consent to this. Sessions Our initial contract will run for six weeks, after which we will review the counselling process and negotiate further sessions as appropriate. Normally we will meet on a weekly basis at a regular time. 32 Section 2: Using a structured counselling process Payments/cancellations Each 1-hour session costs $120. Payment will be taken at the beginning of each session and may be made by cash, EFTPOS, credit card, or cheque. Late cancellation fees are payable as follows: 0-24 hours’ notice – full session fee payable. 24-48 hours’ notice – 50% of session fee is payable. Record keeping I will take notes during or after each session to help me keep track of our progress together. These notes will be stored in a private and secure location and may be viewed by you if you so wish. Your counselling records will be kept by the service for a period of seven (7) years from the date of your last contact with the service. Email/telephone contact Email or telephone contact will be limited to practical arrangements only. I will not enter into telephone or email counselling except by prior arrangement. If you are faced with an emergency in between sessions, please contact the appropriate emergency service (see overleaf). In a life threatening situation, call 000 without delay. Ending counselling Normally, the end of counselling would be by mutual prior agreement. However, you have the right to end your counselling at any time. I would appreciate you letting me know if you decide not to return to counselling, giving at least 48 hours notice. If at any time I feel that our counselling is no longer appropriate for you, I will discuss this with you and may suggest discontinuation or a referral to a more appropriate service. Client signature: _________________________ Date: _______ Counsellor signature: __________________________ Date: ________ Source: Adapted from Crane (2013) Supporting clients in decision-making processes “An important set of counselling tasks centres on the process of making choices. There are many situations in which people seek help, and want to talk things through with someone who is independent of their immediate situation, because they cannot decide what to do. Depending on the circumstances, clients may view this kind of task in a variety of different terms: choosing, solving a problem, reviewing options, devising a plan, or making a decision. Each of these tasks involves a process of collecting, appraising, organising and analysing information, leading to a conclusion to which the person makes an emotional and behavioural commitment.” (McLeod & McLeod, 2011, p. 222) While there are a number of issues that may prompt and individual to seek counselling, a very common cause is that clients feel that they need help making an important decision in their lives. As such, counsellors commonly assist clients with decision-making processes. However, that does not mean that counsellors make decisions for their clients. Indeed, counsellors should never make decisions on behalf of their clients, push their own agenda, or provide advice. Instead, counsellors assist clients in the decision-making process by supporting the client through each stage of the process so that the client fully understands their problem, develops achievable goals, cultivates realistic strategies to obtain these goals, and takes practical 33 Study Guide 1: Counselling and the counselling process steps to complete their goal strategies. Essentially, supporting clients in the decision-making process involves the following steps: Encouraging clients to explore their problem. This requires the counsellor to help the client feel comfortable enough to open up and discuss all aspects of their problem. The counsellor uses basic counselling techniques to help the client feel at ease. They then use effective questioning to help the client explore all facets of their problem. Support clients to identify their goals. This involves encouraging the client to not only come to an understanding of their current situation, but to also consider how exactly they would like to improve their situation. The counsellor should encourage the client to think about their overall goals and how these would fit in with their current circumstances. It is important that the counsellor supports the client in identifying goals that are specific, realistic, and achievable. If the client’s goals are too vague, or relate to others instead of themselves, the counsellor will help the client to modify their goals so that they are achievable for the client. Support clients to identify how goals can be achieved. Once the client has decided upon realistic goals, it is important to help them to identify how each of these goals might be achieved. One commonly used technique at this stage is to brainstorm with the client all potential courses of action for achieving their identified goals. It is important to consider the specific steps that would need to be taken to achieve goals. Sometimes the client will be unsure of how to go about achieving their goals so the counsellor may suggest strategies and potential courses or action, however, it is important that counsellor suggestions be treated only as suggestions and not imposed upon the client. Evaluate potential courses of action. Once the brainstorming processes has finished, the client will have to choose a particular course of action. One effective technique to assist clients in this step is to evaluate each of the potential courses of action together. This involves the following steps: Summarising each of the possible courses of action Assisting the client to assess the advantages and disadvantages of each Helping the client assess the overall appropriateness of each possible course of action based on their particular circumstances Assisting the client to thoroughly consider the possible consequences of each course of action Helping the client to rank each potential course of action and decide upon the most appropriate one Selecting a particular course of action. At the end of the process it is important that the client make a firm decision on a particular course of action. Once this is done the counsellor should confirm that the client understands exactly how they will go about implementing this course of action as well as help the client develop contingency plans for each step. Document it. The final step is to document the client’s decision. In some cases the selected course of action may involve the counsellor or their organisation providing additional services or referring the client for additional support. In these cases the counsellor must also ensure that they complete case planning and referral documentation in line with their organisational requirements. 34 Section 2: Using a structured counselling process Self reflection Consider the last significant decision you had to make. Can you remember the process that you went through to make that decision? Do you recall going through any (or all) of the aforementioned steps? Are there any other steps that you took that you think would be useful when working through decision-making with clients? Essentially, counsellors aim to empower the client to complete these decision-making steps in order to explore their problem, identify their goal, generate ideas for how this goal can be achieved, evaluate the alternatives, choose the most appropriate course of action, and implement it. Reading C provides an example of how such a decision-making conversation may take place within a counselling session. Summary This section of the Study Guide discussed the use of a structured approach to counselling. You were introduced to the basic counselling framework and learned about the importance of discussing the counselling process with the client in order to clarify their understanding and expectations from the very beginning of the counselling relationship. You also learned about how counsellors can help clients with decision-making processes. In the next section, you will learn more about the counselling relationship. References Crane, J. (2013). Counselling agreement. Retrieved from http://www.counsellingbristol.co.uk/ wp-content/uploads/2013/01/Counselling_Contract1.pdf Geldard, K. & Geldard, D. (2012). Personal counseling skills: An integrative approach. Springfield, IL: Charles C Thomas. Horton, I. (2012). Structuring work with clients. In C. Feltham & I. Horton (Eds.), The Sage handbook of counselling and psychotherapy (3rd ed.; pp. 122-128). London, UK: Sage. Ivey, A. E., Ivey, M. B.,& Zalaquett, C. P. (2014). Intentional interviewing and counseling: Facilitating client development in a multicultural society (8th ed.). Belmont, CA: Brooks/Cole. Nelson-Jones, R. (2014). Practical counselling and helping skills (6th ed.). London, UK: Sage. McLeod, J., & McLeod, J. (2011). Counselling skills: A practical guide for counsellors and helping professionals (2nd ed.). Berkshire, UK: Open University Press. Assessment activities Assessment activities relevant to this section are contained in Section 2 of your Assessment Book 35 Reading C Study Guide 1: Counselling and the counselling process 36 Section 3 THE HELPING RELATIONSHIP 37 Study Guide 1: Counselling and the counselling process The Helping Relationship About this Section: In this section you will learn how to: − Give attention to the counselling relationship, including: - How to encourage clients to feel at ease and express themselves - How to build empathy and rapport - Active listening skills - How to respectfully respond - Acknowledging and respecting client’s immediate concerns and needs - Affirming the significance of what the client says - How to challenge clients − Become aware of obstacles to the counselling process, including identifying and exploring client anxieties about the counselling process − Enable clients to understand the nature of the counselling services on offer by clarifying, confirming, and modifying their expectations of the counselling services Supporting materials: The following materials supplement the information provided in this section: 1. Reading D 2. Reading E Arguably the most important aspect within the counselling process is the relationship between the counsellor and client. “Clients come to counselling in pain, with problems, with decisions, in crisis and in need of support. They need to relate to or become connected to counsellors as a means of working on their concerns. The counselling relationship is defined here as the quality and strength of the human connection that counsellors and clients share.” (Nelson-Jones, 2014, p. 77) The relationship between counsellor and client lies at the very heart of the counselling process. While many people assume that counsellors are innately skilled at connecting with clients, there are actually many skills and techniques that counsellors must learn to utilise in order to assist them in developing an effective therapeutic alliance. You will learn more about these skills and how to apply them throughout each of the units of this course. This section merely provides a brief introduction to some of the most important basic counselling skills. Self-reflection Take a moment to reflect on what you believe constitutes a good helping relationship. What skills or attributes do you think an effective counsellor must possess? Why? Building rapport One of the most important skills for a counsellor to possess is the ability to build rapport. Building rapport involves establishing a connection with a client so that they feel at ease and 38 Section 3: The helping relationship comfortable enough to express themselves and share their story. Obviously every client is different and so the path to developing rapport is not always the same; however, there are some key techniques that a counsellor can use to improve the efficiency and effectiveness of rapport building. These include: Active listening. Counsellors must show their client that they are actively paying attention to what they are saying or expressing. Active listening requires the use of communication skills such as: − Listening carefully to what the client is saying, both verbally and through their body language. − The use of encouragers and minimal reinforcers (such as nodding or saying “uh-huh”) to encourage the client to continue telling their story. − Paraphrasing and summarising. This involves the counsellor repeating back or summarising the client’s story (using key words) in order to demonstrate that they have listened and understood what the client is saying. − Reflection of feeling and content. This involves the counsellor considering the thoughts and feelings that the client has expressed and reflecting those back to the client. − Checking the accuracy of the counsellor’s understanding through use of check-ins (i.e., questions such as “is that right?” after a paraphrase, summary, or reflection). Mirroring. This involves understanding and copying the client’s own style of communication and posture. This can help clients to feel comfortable with the counsellor and the counselling process (Nelson-Jones, 2014). Empathic responding. Counsellors must take care to respond to both the content of what the client is saying, and the emotions they are experiencing or expressing (Ivey, Ivey, & Zalaquett, 2014). Demonstrating acceptance and respect. It is vital for counsellors to listen and respond without judgement. Self-disclosure. Counsellor self-disclosure can help build rapport by increasing the counsellor’s authenticity, building a sense of trust between client and counsellor, and promoting feelings of universality (Cormier, Nurius & Osborn, 2013). However, selfdisclosure must always be used with extreme care. If it is done for the wrong reasons, used excessively, or used too early in the counselling relationship, it may do more harm than good. Self-reflection Take a moment to reflect upon your current skills in developing rapport with others. Do you find it easy to converse with and empathise with others? What skills do you think you need to develop? Microskills Microskills are vital for building rapport with clients and usually form the basis of an effective counselling relationship. The table on the next two pages provides a brief overview of the main microskills that are used in counselling. 39 Reading D Study Guide 1: Counselling and the counselling process Microskill Description of Skill Anticipated Impact on Client Attending Behaviour “Support your client with individually and culturally appropriate verbal following, visuals, vocal quality and body language” (p. 65). “Clients will talk more freely and respond openly, particularly about topics to which attention is given. Depending on the individual client and culture, anticipate fewer breaks in eye contact, a smoother vocal tone, a more complete story (with fewer topic jumps), and a more comfortable body language” (p. 65). Empathy “Experiencing the client’s world and story as if you were the client; understanding his or her key issues and saying them back accurately, without adding your own thoughts, feelings, or meanings. This requires attending and observation skills plus using the important key words of the client, but distilling and shortening the main ideas” (p. 73). “Clients will feel understood and engage in more depth in exploring their issues. Empathy is best assessed by the client’s reaction to a statement and his or her ability to continue the discussion in more depth and, eventually, with better self-understanding” (p. 73). Observation “Observe your own and the client’s verbal and nonverbal behaviour. Anticipate individual and multicultural differences in nonverbal and verbal behaviour. Carefully and selectively feed back some here-and-now observations to the client as topics for exploration” (p. 92). “Observations provide specific data validating or invalidating what is happening in the session. Also, they provide guidance for the use of various microskills and strategies. The smoothly flowing session will often demonstrate movement symmetry or complementarity. Movement dissynchrony provides a clear cue that you are not “in tune” with the client” (p. 92). Questioning “Begin open questions with the often useful who, what, when, where, and why. Could, can, or would questions are considered open but have the additional advantage of being somewhat closed, thus giving more power to the client, who can more easily say that he or she doesn’t want to respond. “Clients will give more detail and talk more in response to open questions. Could, would, and can questions are often the most open of all, because they give clients the choice to respond briefly (“No, I can’t”) or, much more likely, explore their issues in an open fashion. Closed questions may start with do, Closed questions may provide is, or are” (p. 119) specific information but may close off client talk” (p. 119). 40 Section 3: The helping relationship Encouraging “Encouraging (using encouragers and restatements): Give short responses that help clients keep talking. They may be verbal statements (repeating key words and short statements) or nonverbal actions (head nods and smiling)” (p. 140). “Clients elaborate on the topic, particularly when encouragers and restatements are used in a questioning tone of voice” (p. 140). Paraphrasing “Paraphrasing (also known as reflection of content): Shorten, clarify the essence of what has just been said, but be sure to use the client’s main words when you paraphrase. Paraphrases are often fed back to the client in a questioning tone of voice” (p. 140). “Clients will feel heard. They tend to give more detail without repeating the exact same story. If a paraphrase is inaccurate, the client has an opportunity to correct the counsellor” (p. 140). Summarising “Summarise client comments and integrate thoughts, emotions, and behaviours. This technique is similar to paraphrase but used over a longer time span. Important in the summary is that you seek to find strengths and resources that support the client” (p. 140). “Clients will feel heard and often learn how the many parts of their stories are integrated. The summary tends to facilitate a more centred and focused discussion. The summary also provides a more coherent transition from one topic to the next or a way to begin or end a full session” (p. 140). Reflection of Feelings “Identify the key emotions of a “Clients will experience and client and feed them back to clarify understand their emotional state affective experience. With some more fully and talk in more depth clients, the brief acknowledgement about emotions and feelings. They of a feeling may be more may correct the counsellor’s appropriate. Often combined with reflection with a more adequate paraphrasing and summarizing” (p. descriptor” (p. 161). 161). Source: Adapted from the indicated pages of Ivey, Ivey & Zalaquett (2014) Please note: You will learn more about these skills and how to apply them in the next few Study Guides of this Diploma. At this stage, it is simply important for you to remember that an effective, positive relationship between counsellor and client is central to the success of counselling. The counsellor’s ability to apply counselling microskills to draw out, listen to, and fully understand the client’s concerns, as well as the ability to convey this understanding to the client, are central to building an effective counselling relationship (Nelson-Jones, 2014). Self-reflection Can you think of a time in which you confided in or sought advice from someone and felt that they were really listening to you? In what ways did they show you that they were listening? Did they use any of the basic counselling microskills or techniques that we have discussed? 41 Study Guide 1: Counselling and the counselling process Obstacles to the counselling process Despite your best efforts and use of microskills, you may find yourself unable to build rapport with some clients. This can be for a number of reasons, including the presence of obstacles to the counselling process. Being aware of any potential obstacles that could disrupt, or even completely stop, the counselling process or the development of rapport will make it easier to deal with if and when they arise. We will now discuss some of the most common obstacles to the counselling process and development of rapport. Client anxieties Most clients enter counselling while in a heightened state of emotion that can make the process of developing rapport and building an effective counselling relationship quite difficult. New clients are often anxious, upset, or in turmoil. Some new clients may be content to express these emotions to their counsellor; however, many will have difficulty with opening up to a complete stranger and sharing stories and concerns that they may not have even shared with their family and closest friends. In the early stages of the working relationship, one of the primary goals should be to establish trust and a shared understanding of what the counselling process will entail. This can be done by using the usual rapport building strategies; however, you may find this process will take longer for some clients than for others. You should also explain to the client what they can expect from the counselling sessions in general, as well as from you as the counsellor, and make sure to answer any questions they have about the process. Once the client’s anxiety levels about the process have been reduced, you can start building a truly effective helping relationship. Differences in background, culture, and values Another essential part of the counselling relationship is the counsellor’s ability to understand clients in the social, cultural, and personal contexts in which they live. Disruptions to the counselling process may occur if the counsellor is unable to do this. The following extract outlines just some of the many areas of diversity to consider when practicing counselling. RESPECTFUL Counseling and Psychotherapy “The RESPECTFUL model (D’Andrea & Daniels, 2001; Ivey, D’Andrea, & Ivey, 2012) makes it clear that multiculturalism refers to far more than race and ethnicity. As you review the list below, first identify your own multicultural background. Then examine your beliefs and attitudes toward those who are culturally similar to and different from you on each issue. How prepared are you to work with clients who are culturally different from you? And all clients are culturally different in some way.” R E S P E C Religion/spirituality. What is your religious and spiritual orientation? How does this affect your thoughts, feelings, and behaviors as a counselor? Economic/class background. How will you work with those whose financial and social background differs from yours? Sexual orientation and/or gender identity. How effective will you be with those whose gender and/or sexual orientation differs from yours? Personal style and education. How will your personal style and educational level affect your practice? Ethnic/racial identity. The color of a person’s skin is one of the first things we notice. What is your reaction to different races and ethnicities? Chronological/lifespan challenges. Children, adolescents, young adults, mature adults, and older people all face different issues and challenges. Where are you in the 42 Section 3: The helping relationship T F U L developmental lifespan? Trauma. It is estimated that 90% or more of all people experience serious trauma in their lives. Trauma underlies the issues faced by many of your clients. War, flood, rape, and assault are powerful examples, but a serious accident, divorce, loss of a parent, or being raised in an alcoholic family are more common sources of trauma. The constant repetition of racist, sexist, or heterosexist actions and comments can also be traumatic. What is your experience with life trauma? We now recognize it as a “normal” part of being alive for most of us. Family background. We learn culture in our families. The old model of two parents with two children is challenged by the reality of single parents, gay families, and varying family structures. How has your life experience been influenced by your family history (both your immediate family and your intergenerational history)? Unique physical characteristics. Become aware of disabilities, special challenges, and false cultural standards of beauty. In addition, physical health is a key part of mental health. Exercise, nutrition, yoga, and meditation are not traditionally included as part of formal helping theory and practice, but research and clinical experience have now changed our view and these are an essential part of modern counseling. How well do you understand the importance of the body in counseling and psychotherapy, and how will you work with others different from you in their physical characteristics and interests? Location of residence and language differences. Whether in the United States, Great Britain, Turkey, Korea, or Australia, there are marked differences between the south and north, east and west, urban and rural. Moreover, many of you reading this book, and certainly many of your clients, will come from a wide variety of nations. The small town of Amherst, Massachusetts, has 23 different languages represented in their schools. Remember that a person who is bilingual is advantaged and more skilled, not disadvantaged. What languages do you know, and what is your attitude towards those who use a different language from you?” (Ivey, Ivey & Zalaquett, 2014, pp. 18-19) Self-reflection Complete the exercise described in the extract above. Thinking about the different dimensions of the RESPECTFUL model can be a very useful exercise for helping new counsellors to understand themselves as a cultural being. Consider what you have learned about yourself from this exercise. Also, consider what steps you could take to increase your awareness and ability to work with clients who are different to yourself. One way to ensure that differing cultures, backgrounds, and values do not disrupt the counselling process is to make sure you manage your own values. Counsellors must ensure that they understand their own reactions and motivations within the counselling relationship. Counselling is not about pushing a person in a certain direction, judging a client or giving them advice. Counsellors must show respect for the diversity of the client by not imposing their own values, attitudes, beliefs, and behaviours upon them. Self-awareness is a vital skill for counsellors to possess. Throughout your development as a counsellor you must ensure that you continually assess your personal strengths and limitations in this regard. Developing the competence to work with clients from a diverse range of backgrounds involves ongoing personal and professional development. Please note that issues 43 Reading E Study Guide 1: Counselling and the counselling process of diversity in counselling are explored in more detail later in the course (Study Guide 17 – Working with Diversity). Clients with insufficient self-awareness Often clients come to counselling without having an accurate understanding of their own thoughts, emotions and behaviours. For example, some clients: Distance themselves from their thoughts or emotions by speaking in abstract or general terms rather than expressing themselves directly. Demonstrate inconsistencies in their behaviours and in what they say they want. Have distortions in their thoughts, such as “I need to do something perfectly or there is no point doing it at all” or “I’m a failure, I never do anything right”. Fail to see other opportunities or courses of action. Such clients may have difficulty embracing the counselling process because they often underestimate their ability to make positive changes in their own lives. Sometimes clients are ‘stuck’ in a particular pattern of behaviour and even though they work through strategies to change those behaviours within counselling sessions, they may not implement these strategies in their life outside the counselling environment. One effective approach for a counsellor to assist such clients is to utilise the skill of welltimed challenging. Challenging is the process of acknowledging and reflecting client’s discrepant, inconsistent, and mixed messages. For example, when dealing with a client who has thought distortions (e.g., “I need to do something perfectly or there is no point doing it at all” or “I’m a failure, I never do anything right”) the counsellor may ask “Where is the evidence for that?” or may challenge the client’s existing perceptions by offering new perceptions or ways of viewing problematic situations. When challenging, it is important to start with an accurate reflection of the client’s previous message (Ivey, Ivey & Zalaquett, 2014). This demonstrates that the counsellor has understood the client and acknowledged their viewpoint. By taking these steps, the client is more likely to be open to the content of the challenge. Care must also be taken with the strength and frequency of challenges. It is important to ensure that the counselling environment remains a safe, supportive, and therapeutic space by not over-doing it. You should only challenge a client after a counselling relationship has been established, when you have the time and effort to continue building the relationship, and when you know your own motivations for doing it. Clients who are unsure of where to begin Sometimes clients will come into counselling not knowing the main concern that they would like to focus on. They may mention numerous concerns and it will be unclear which one takes precedence. When clients have a number of concerns, the best thing to do is to summarise and acknowledge them all and then ask the client to pick one to focus on. Alternatively, some clients may spend the majority of the first session focusing on small issues because they are too uncomfortable to talk about what is really bothering them. In such cases it is important for the counsellor to develop rapport and help the client feel understood by affirming everything that the client has said, no matter how small the problem may seem. Acknowledging these concerns can help the client to feel free to talk about the more important ones. 44 Section 3: The helping relationship Demanding and unmotivated clients A demanding client is one who may believe that the counsellor will provide answers to all of their problems. They may come into counselling with unrealistic expectations about the counselling process or their relationship with the counsellor. Some traits of demanding clients include: Telephoning frequently and expecting free and immediate counselling Demanding more sessions than the counsellor believes is necessary Demanding more time during sessions Demanding that the counsellor socialise with them Attempting to get the counsellor to take responsibility for their problems and/or life Forcefully arguing their point of view Expecting the counsellor to manipulate another person to have their needs met Expecting the counsellor to provide them with solutions to their problems. Beginner counsellors often find demanding clients quite difficult to work with. Some techniques that you may use when dealing with such behaviours include: Be assertive. It is important to be clear and firm with such clients. Have an understanding of the reasons why these demands are being placed on you. By considering the underlying reasons for demanding behaviour you will be better able to effectively deal with it. Confront the demand in an appropriate manner. Such behaviours should be discussed within the counselling sessions and clarifications surrounding the role of the counsellor and the boundaries of counselling should be made. Understand and acknowledge your reactions to such behaviour. Some counsellors possess the need to be ‘liked’ by or to ‘help’ all of their clients. This can often lead to counsellors giving in to demanding behaviours. By understanding your internal reaction to demanding behaviour you will be better able to keep professional boundaries. Conversely, a lack of commitment can also be a challenging problem in the counselling process. A lack of motivation and commitment can be common in involuntary clients (for example someone who has been referred to drug counselling as part of a criminal sentence or a husband who has been forced by his wife to attend couple’s counselling in order to preserve their marriage). Some typical characteristics of the uncommitted client include: They may forget appointments They may show indifference to the counsellor and the counselling process They may not actively participate in the counselling process They may not take responsibility for their own problems Generally, counsellors are motivated to help their clients. As such, it can be a source of dismay and frustration for a counsellor when their efforts are met with disengagement or resistance. When this persists counsellors may find themselves feeling defensive, rejected and even angry. While this is an understandable reaction, it is important for the counsellor to clearly identify the reasons for this reaction and to develop strategies for dealing with it. Framing and reframing (in which the counsellor works with the client to shift the client’s point of view) are good tactics to re-model the way the client perceives the counselling relationship. Creating 45 Study Guide 1: Counselling and the counselling process goals and structuring can also motivate clients to engage in the helping relationship. The creation of a counselling contract, as discussed in Section 2, can also help to clarify the client’s expectations, inform them of their duties, and confirm their commitment to the counselling process. Summary In this section, you learned about how to establish the helping relationship through use of microskills and rapport building. You also learned about some of the obstacles to the counselling process and helping relationship that might arise, such as differences in culture and values, and demanding clients. References Cormier, S., Nurius, P. S., & Osborn, C. J. (2013). Interviewing and change strategies for helpers (7th ed.). Belmont, CA: Brooks/Cole. Ivey, A. E., Ivey, M. B.,& Zalaquett, C. P. (2014). Intentional interviewing and counseling: Facilitating client development in a multicultural society (8th ed.). Belmont, CA: Brooks/Cole. Nelson-Jones, R. (2014). Practical counselling and helping skills: Texts and activities for the lifeskills counselling model (6th ed.). Dorchester, UK: Sage Publications. Assessment activities Assessment activities relevant to this section are contained in Section 3 of your Assessment Book. 46 Section 4 COUNSELLOR RESPONSIBILITES 47 Study Guide 1: Counselling and the counselling process Counsellor Responsibilities About this Section: In this section you will learn to: Identify ethical responsibilities in providing counselling, including limits of competence and responsibility and individual need for support and supervision Identify indicators of client issues requiring referral and report or refer appropriately, in line with organisation requirements and protocols. Indicators may include indications of physical or mental ill health Maintain documentation as required, including policy and principles to secure and maintain confidentiality, and clearly explain these policies to the client Be aware of organisational role and responsibilities Supporting materials: The following materials supplement the information provided in this section: 1. Reading F 2. Reading G 3. You may also access and download the Australian Counselling Association’s Code of Ethics and Practice from http://www.theaca.net.au/documents.php Counsellors must always be mindful of meeting their client’s needs and ensuring that the counselling relationship is appropriate for a helping relationship. This means making sure to uphold all legal and ethical responsibilities and ensuring that their level of skill and knowledge is suitable for each individual client. When a counsellor becomes aware that either they or the organisation that they work for does not have the expertise to deal with a particular client’s concerns, they should discuss appropriate referral with the client. In this section, you will learn about how to confirm the appropriateness of the helping relationship by adhering to your ethical responsibilities. Supervision Reading F One of the most important responsibilities you will have as a counsellor is to access appropriate professional supervision. Supervision is also a mandatory requirement for many professional counselling organisations, including Australia’s largest registration body for counsellors, the Australian Counselling Association (ACA). “Supervision is: A formal arrangement for counsellors to discuss their work regularly with someone who is experienced in counselling and supervision. The task is to work together to ensure and develop the efficiency of the counsellor/client relationship. Professional supervision is a process to maintain adequate standards of counselling and a method of consultancy to widen the horizons of an experienced practitioner. Counselling exposes counsellors to situations that impose a great demand on practitioners’ emotional and professional well-being. This demand can lead to becoming enmeshed and over-involved leading to ineffective practices. A supervisor can be objective and help the counsellor to grow and learn. The supervisor can ensure that the counsellor is meeting the 48 Section 4: Counsellor responsibilities needs of their clients and keeping to ethical and professional standards. Supervisors will also help counsellors relate practice to theory and visa versa. Supervisors are more likely to identify potential mental health issues in the Supervisee before they become a problem.” (Australian Counselling Association, 2013a, p. 4-5) Supervision can be conducted in one-on-one, in a group setting, or with a peer. While supervision is a requirement for all counsellors, no matter how many years they have been practicing, it is particularly helpful for new counsellors to ensure the client is receiving an appropriate service. Counsellor responsibilities to clients The process of counselling can put a client into a very vulnerable position. Because of this, the counsellor must be aware of the responsibilities they have to the client and their well-being. The ACA provides a consistent Code of Conduct and Practitioner Standards that can be used to guide counsellors in their responsibilities. Their Code of Ethics and Practice outlines several of the ethical responsibilities a counsellor must adhere to when working with clients. We will discuss several of them here. Confidentiality Clients are entitled to receive a confidential service and be aware of the limits to that confidentiality. The ACA Code of Ethics states: “3.7 Management and Confidentiality (a) Counsellors should ensure that records of the client’s identity are kept separately from any case notes. (b) Arrangements must be made for the safe disposal of client records, especially in the event of the counsellor’s incapacity or death. (c) Care must be taken to ensure that personally identifiable information is not transmitted through overlapping networks of confidential relationships. (d) When case material is used for case studies, reports or publications the clients informed consent must be obtained wherever possible and their identity must be effectively disguised. (e) Any discussion of their counselling work with other professionals should be purposeful and not trivializing. (f) Counsellors must pay particular attention to protecting the identity of clients.” (Australian Counselling Association, 2013b, p. 9) Thus, in order to protect client’s personal information, both computerised and hard copy records must be kept securely so they are only accessible by authorised personnel. However, as a general rule, there are several circumstances in which confidentiality can be breached. This includes situations when: Your client discloses that they may harm themselves or another person; or Your client discloses that they have committed a crime; or Your client file is subpoenaed by a court of law; or You have the client’s written permission to do so These situations are known as ‘exceptional circumstances’. In regards to exceptional circumstances, the ACA Code of Ethics states: 49 Reading G Study Guide 1: Counselling and the counselling process “3.6 Exceptional Circumstances (a) Exceptional circumstances may arise which give the counsellor good grounds for believing that serious harm may occur to the client or to other people. In such circumstance the client's consent to change in the agreement about confidentiality should be sought whenever possible unless there are also good grounds for believing the client is no longer willing or able to take responsibility for his/her actions Normally, the decision to break confidentiality should be discussed with the client and should be made only after consultation with the counselling supervisor or if he/she is not available, an experienced counsellor. (b) Any disclosure of confidential information should be restricted to relevant information, conveyed only to appropriate people and for appropriate reasons likely to alleviate the exceptional circumstances. The ethical considerations include achieving a balance between acting in the best interests of the client and the counsellor’s responsibilities under the law and to the wider community. (c) While counsellors hold different views about grounds for breaking confidentiality, such as potential self-harm, suicide, and harm to others they must also consider those put forward in this Code, as they too should imbue their practice. These views should be communicated to both clients and significant others e.g. supervisor, agency, etc.” (Australian Counselling Association, 2013b, p. 9) Self-reflection How easy or difficult do you believe it will be to uphold your client’s right to confidentiality? How would you feel if your client told you that they were planning to hurt someone? What actions do you believe you should take? As a counsellor, it is your responsibility to promote your client’s understanding of these rights and limitations by outlining the concept of confidentiality and its limits at the beginning of the counselling relationship. Your client needs to be aware of what circumstances may warrant a breach of confidentiality from you. Professional boundaries Boundaries between the counsellor and their client provide a consistent framework and structure for their working relationship and the counselling process. Counselling is generally a vulnerable experience for the client. They may not know what is going to happen or how the counsellor is going to react to them. They will tell the counsellor their most intimate secrets, while the counsellor may share almost nothing about themselves. This creates an imbalance of power that the counsellor must remain sensitive to. By maintaining professional boundaries, the counsellor can protect both themselves and the client from poor or unethical practice. In regard to boundaries between counsellors and clients (and former clients), the ACA Code of Ethics and Practice states: “3.9 Boundaries (d) With Clients i. Counsellors are responsible for setting and monitoring boundaries throughout the counselling sessions and will make explicit to clients that counselling is a formal and contracted relationship and nothing else. ii. The counselling relationship must not be concurrent with a supervisory, training or other form of relationship (sexual or non-sexual). 50 Section 4: Counsellor responsibilities (e) With Former Clients i. Counsellors remain accountable for relationships with former clients and must exercise caution over entering into friendships, business relationships, training, supervising and other relationships. Any changes in relationship must be discussed in counselling supervision. The decision about any change(s) in relationships with former clients should take into account whether the issues and power dynamics presented during the counselling relationship have been resolved. Section 3.9 (b) ii below is also of relevance here. ii. Counsellors are prohibited from sexual activity with all current and former clients for a minimum of two years from cessation of counselling.” (Australian Counselling Association, 2013b, p. 11) Self-reflection Sometimes clients may view their counsellors as friends and try to engage them in a concurrent relationship by inviting them to birthday parties or buying them gifts. Take a moment to consider what the appropriate action would be in cases like this. Counsellor competence It is vital that counsellors ensure that their level of skill and knowledge is appropriate to meet client needs. In regard to counsellor competence, the ACA Code of Ethics and Practice states: “3.10 Competence (a) Counsellor Competence and Education i. Counsellors must have achieved a level of competence before commencing counselling and must maintain continuing professional development as well as regular and ongoing supervision. ii. Counsellors must actively monitor their own competence through counselling supervision and be willing to consider any views expressed by their clients and by other counsellors. iii. Counsellors must have a zero tolerance alcohol and illicit drug policy in their workplace and, for the counsellor, up to eight hours before – and of course during – their working hours. Counsellors are responsible for monitoring their functioning and will not counsel when their functioning is impaired by alcohol or drugs (be they illicit or licit). In situations of personal or emotional difficulty, excessive tiredness or illness, counsellors will monitor the point at which they are no longer competent to practice and take action accordingly. Counsellors should always err on the side of caution in such cases. iv. Competence includes being able to recognise when it is appropriate to refer a client elsewhere. v. Counsellors should take reasonable steps to seek out peer supervision to evaluate their efficiency as counsellors on a regular basis as required by the ACA (INC) membership guidelines. vi. Counsellors must recognise the need for continuing education in their chosen profession to maintain a professional level of awareness of current scientific and professional information and education in their particular fields of activity. vii. Counsellors should take steps to maintain and improve their level of competence though on-going professional development and to keep up to date with best practice. viii. Counsellors are responsible for ensuring that their relationships with clients are not unduly influenced by their own emotional needs. 51 Study Guide 1: Counselling and the counselling process ix. x. Counsellors must have professional indemnity insurance and maintain adequate cover When uncertain as to whether a particular situation or course of action may be in violation of the Code of Ethics and Practice, counsellors must consult with their counselling supervisor and/or other practitioners.” (Australian Counselling Association, 2013b, p. 12) As you can see, counsellor competence refers to many areas of practice, including professional knowledge, referral, and attention to a counsellor’s own emotional needs. Counsellors must ensure that they take care of their own emotional needs and manage stressors both in their personal and professional lives. Counselling can be a mentally and emotionally challenging role, therefore, it is important that counsellors become aware of their own strengths and limitations and implement self-care strategies to ensure they do not experience vicarious trauma or burnout. Adaptive coping and self-care strategies commonly used by counsellors include taking care of themselves through exercise and a healthy lifestyle, expressing their feelings, seeking support from their personal and professional networks, and using problem solving techniques. Self-reflection Are you aware of your own personal strengths and limitations? What self-care strategies do you currently use? Reading F Referral Another responsibility that counsellors have to clients is that of appropriate referral. According to the ACA Code of Ethics and Practice, counsellors should “endeavour to make suitable referral where competent service cannot be provided” (Australian Counselling Association, 2013a, p. 4) and is another aspect of counsellor competence. Understanding your own competence, strengths, and limitations will help you to be realistic about the kinds of clients and cases that you excel at and the areas that you may require more practise in. If you feel that you lack experience and skills in a particular area of counselling you may need to refer the client to a counsellor who specialises in that area. For example, if you are working with a client who presents with depression only to find that she has deep seated post-traumatic stress, an area you do not have experience in, you should either refer the client or ensure that you have an experienced supervisor who can guide you in this work. Some of the areas that specialist counselling services may be needed include: Child protection issues – state or territory child protection agencies need to be contacted if there are concerns about a child’s safety or suspicions of abuse or neglect. The agency may take over the management of the case until the concerns have been investigated or appropriate action has been taken. Suicide prevention/intervention – beginner counsellors especially should ensure they have the necessary support (e.g., from a supervisor or more experienced counsellor) to deal with suicidal clients. In some cases the client may be hospitalised until they are assessed as no longer a risk to themselves. Domestic and family violence – counsellors should be aware of other agencies specialising in domestic abuse and counselling. Knowledge of local services, such as women’s or men’s shelters, is also important. 52 Section 4: Counsellor responsibilities Mental health issues – clients showing signs of psychiatric illness need to be referred for appropriate specialist care. Indicators include hallucinations, strange or erratic behaviour, extreme mood swings, agitation, aggression, extreme withdrawal, unusual or exaggerated beliefs, paranoia, or problems with logical thinking. Alcohol and other drugs issues – clients with substance abuse problems may require referral to a range of specialist services such as medical services, detoxification centres, rehabilitation services, or addictions counselling. Other compulsions – depending on the counsellor’s training and experience, behaviours such as compulsive gambling, compulsive eating or sex addiction may require referral to an appropriate specialist. Financial counselling – despite their title, financial counsellors have little in common with the regular type of counsellor. Clients in financial difficulty may benefit from seeing a financial counsellor for assistance with budgeting, debt management, and dealing with debt collection agencies. Bereavement issues – clients with complicated or traumatic grief reactions may be referred to a grief specialist. Physical illness – most counsellors do not have a medical background and should not attempt to treat or give advice about clients’ physical health problems. Some clients may require counselling in conjunction with medical treatment (e.g., clients with eating disorders, chronic pain, or substance issues) and so will be working with more than one professional at once. It is also wise to ensure that clients presenting with somatic complaints (e.g., headaches, stomach pain) have been thoroughly medically evaluated. If you work for a counselling service or other type of agency providing community services you will need to follow organisational guidelines regarding referral. For example, your service may have a policy that any client who is showing signs of acute mental illness or who mentions that they have considered suicide should be referred immediately to a service that specialises in helping people in these situations. This ensures that the client is thoroughly assessed and receives the help they need, which may be hospitalisation or the services of a clinical outreach team. Most organisations/services will provide training for new counsellors in their policy regarding referrals and how to recognise the signs that a client may need specialised services. In cases where you are unsure whether a client requires referral or not, you should accurately and objectively record the client’s behaviour, including what they have said that has caused you concern. You should then discuss the matter with your supervisor or manager. By taking these two steps you are acting in the best interests of the client, adhering to organisational guidelines, and ensuring that you meet your duty of care responsibilities. As Geldard and Geldard (2012) point out in the following extract, it is also important that counsellors do not refer every difficult client they come across. “When a client’s needs cannot be adequately met by a counselor, then that counselor has a responsibility to make an appropriate referral, in consultation with the client, to another suitable professional. However, it is not appropriate for a counselor to avoid all difficult and unenjoyable work by excessively referring people to others. There is a responsibility on all 53 Study Guide 1: Counselling and the counselling process counselors to carry a fair load, and to be sensible about referral decisions. Such decisions are best made in consultation with a supervisor. It may sometimes be appropriate for a counselor to continue seeing a client while under intensive supervision, instead of referring. If this happens, then the counselor has a responsibility to inform the client. Often, referral is useful where people have special needs. For example, people with particular disabilities, people from other cultures and people who speak another language may benefit from referral to an agency (or professional) that can provide for their specific needs. When referring clients to others, it may be useful to contact the professional to whom the referral is being made, with the client’s permission, to ensure that the referral is acceptable and appropriate.” (Geldard & Geldard, 2012, p. 266) Some organisations will have a standard form that all outgoing referrals must be carried out on. The following is an example of a client referral form. CLIENT REFERRAL FORM REFERRAL TO: (service) __________________________________________________ Date of Referral: Client’s Details Name: Client consented to referral? □ Yes □ No DOB: Gender: □ Male □ Female Preferred Contact (e.g. phone, mobile, email, post): Relationship: Contact Phone: Address: Name of Next of Kin/Emergency Contact: Indigenous/Cultural Identity: Referrer Details: Name: Address: Organisation and Position: Email: Phone: Fax: Reason/s For Referral (Please include here any information which may be useful as background information to assist with the referral e.g. Mental Health, Drug and Alcohol, Vocational/Educational, Physical Health, including past/current risk assessments). ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Is the young person linked in with any other services? Yes □ No □ If yes, please provide details: Referrer signature: ______________________ Date: ______________ Source: Adapted from: www.headspace.org.au 54 Section 4: Counsellor responsibilities A note on the importance of exploring relationship alternatives Some clients may benefit from additional or alternative services. We have already explored the circumstances under which you may need to refer a client to another professional but at times you may need to consider other options as well. In some circumstances, a client may gain benefit from different types of support, for example, a client who has been coming to you for some time for help in overcoming social phobia may benefit from actually joining a self-help group for people with social phobia. This option would be most beneficial for a client who has been attending counselling for some time and who has made progress but now needs to take steps to maintain their progress. Similarly, a client who has been attending bereavement counselling may find that they can benefit from joining a group where they can give and receive support from others who have been through a similar experience. Other options that can be offered in addition to individual face-to-face counselling or as an alternative to counselling include: Group counselling Peer support Self-help groups Counselling hotlines or telephone counselling services Online counselling Monitoring the counselling process Part of the counselling process involves checking that the client is satisfied with the counselling that you are providing. This may involve giving the client a feedback form to fill in or conducting a verbal review of the counselling process with the client. Reviews can be conducted in a variety of ways. Some organisations will have procedures in place that outline how counselling reviews are to be conducted. Nonetheless you may wish to conduct additional reviews to assist you in assisting your client. The initial counselling contract should outline the review process for the client. A review should include: Review of the progress that has been made towards the client’s goals. Evaluation of the counselling relationship (from the client’s perspective). Evaluation of the pace of the counselling progress. Re-evaluation of the termination (final session) date. Feedback from the client on what is working well for them and what is not. The frequency of reviews is up to you and your client. Some counsellors choose to conduct a brief review after every session; others choose a predictable time-frame, such as every three sessions or every six weeks. Counsellor responsibilities to their organisation While a counsellor has many responsibilities to their client, they also have responsibilities to themselves and to the organisation that they work for. Counsellors who work within organisations must ensure that they understand their role within their organisation and what is expected of them, as well as provide services according to organisational policies and procedures. This means using counselling methods preferred by the organisation and working within agency resources. Most organisations will have specific guidelines about how clients’ needs should be met and will expect that counselling staff adhere to these guidelines. Counsellors should ensure that they are familiar with the organisation’s policies and procedures regarding working with clients, including being familiar with the maintenance of 55 Study Guide 1: Counselling and the counselling process client records, Work Health and Safety (WHS) guidelines, and need for professional supervision. Most organisations/agencies require staff to document each client session in the form of case notes. If these are handwritten, they must be kept in the client’s file in a secure location not easily accessible by third parties (e.g., a locked filing cabinet in the counsellor’s office, which is also locked overnight). These days, most organisations document electronically (or use a combination of electronic and handwritten documentation). Maintaining client documentation electronically involves a number of considerations, including: Security – who can access the computer or other hardware? Is it password protected? If files are stored on a central server, are there appropriate restrictions in place for their access? Is there internet security/virus protection installed? Physical premises – check your organisation’s policy about client files leaving the premises. For example, if you take work home on a USB stick you will need to take extra precautions to protect that information. Health and safety issues – the use of any information technology must occur in line with Work Health and Safety (WHS) guidelines. Typically these include things like workspace setup, posture and appropriate seating, taking regular breaks from the computer screen, and ensuring electronic devices are regularly serviced and maintained so as to reduce fire hazards. Summary In this section you were introduced to the responsibilities you will have as a counsellor, including respecting client confidentiality, professional boundaries, and ensuring that you have the appropriate skills and competence. This section also outlined the process of referral and some of the responsibilities counsellors have to the organisations for which they work. You will learn much more about these responsibilities as you progress through your Diploma. References Australian Counselling Association (2013a). ACA policy document on professional supervision. Retrieved from: https://www.theaca.net.au/documents/ACA%20Supervision%20Policy%202013.pdf Australian Counselling Association (2013b). Code of ethics and practice of the association for counsellors of Australia. Retrieved from: http://www.theaca.net.au/documents/ACA%20Code%20of%20Ethics%20and%20Pra ctice%20Ver%2010.pdf Geldard, K., & Geldard, D. (2012). Personal counseling skills: An integrative approach. Springfield, IL: Charles C Thomas. Headspace. (n.d.). Referral form. Retrieved from http://www.headspace.org.au/media/301131/headspace%20referral%20form.doc Assessment activities Assessment activities relevant to this section are contained in Section 4 of your Assessment Book. 56 READINGS A – G 57 58 Reading A An Introduction to Counselling (5th ed.) John McLeod Open University Press Berkshire, UK, 2013 PART I: PGS 3 – 16 PART II: PGS 31 – 35 59 Study Guide 1: Counselling and the counselling process PART I: WHAT IS COUNSELLING? Introduction challenging. There is always more to learn. The role of counsellor lends itself to flexible work arrangements. There are excellent counsellors who are full-time paid staff; others who work for free in the evenings for voluntary agencies; and some who are able sensitively to offer a counselling relationship within other work roles, such as nurse, doctor, clergy, social worker, or teacher. Counselling is an activity that emerged during the twentieth century, and reflects the pressures and values of modern life. We live in a complex, busy, changing world. In this world, there are many different types of experiences that are difficult for people to cope with. Most of the time, we get on with life, but sometimes we are stopped in our tracks by an event or situation that we do not, at that moment, have the resources to sort out. Most of the time we find ways of dealing with such problems in living by talking to family, friends, neighbours, priests or our family doctor. But occasionally their advice is not sufficient, or we are too embarrassed or ashamed to tell them what is bothering us, or we just do not have an appropriate person to turn to. Counselling is a really useful option at these moments. In most places, counselling is available fairly and quickly, and costs little or nothing. The counsellor is someone who does his or her best to listen to you and work with you to find the best ways to understand and resolve your problem. Counsellors do not diagnose or label people, but instead do their best to work within whatever framework of understanding makes most sense for each client. For some people, one conversation with a counsellor is sufficient to make a real difference to them. Other people will need to see their counsellor on a regular basis for months or years. These can be precious hours. Where else in our society is there the opportunity to be heard, taken seriously, understood, to have the focused attention of a caring other for hours at a time without being asked to give anything in return? This book is about counselling. It is a book that celebrates the creative simplicity of counselling as a cultural invention that has made a huge contribution to the quality of life of millions of people. The aim of this book is to provide a framework for making sense of all the different aspects of counselling that exist in contemporary society, while not losing sight of its ordinary simplicity and direct human value. Counselling in action The following paragraphs reflect some typical examples of counselling, in terms both of different problems in living that can be tackled through counselling, and the different counselling processes that can occur. Donald's story: coming to terms with the pressure of work As a manager in a local government department, Donald continually felt himself to be under pressure, but able to cope. Following a series of absences for minor illnesses, the occupational health nurse within the authority suggested to Donald that it might be helpful for him to see one of the counsellors contracted to the occupational health service. Initially, Donald thought it would be a sign of weakness to see a counsellor. He was also worried that other people in the organization might view him as having mental health problems, and begin to see him as unreliable. Following further discussion with the occupational health nurse, Donald accepted that counselling was completely confidential, and might have something to offer. In the eight counselling sessions that he attended, Donald made two important discoveries about himself. First, he Being a counsellor is also a satisfying and rewarding work role. There are times when, as a counsellor, you know that you have made a profound difference to the life of another human being. It is always a great privilege to be allowed to be a witness and companion to someone who is facing their own worst fears and dilemmas. Being a counsellor is endlessly 60 Reading A realized the extent to which he was driven by his father's ambition for him, to the extent of never being satisfied with his own achievements, and as a result being very reluctant to take holidays from work. He also reflected, with the help of his counsellor, on his unwillingness to accept support from other people, not only at work, but also in the context of his family life. With the encouragement of his counsellor, Donald began to make some shifts in his behaviour, in relation to arranging time off, and making opportunities to speak about his concerns to his wife, and to another close colleague. At the end of the counselling, he described it as having given him an opportunity to 'sort himself out'. Maria and her counsellor developed strategies that allowed her to deal with the many demands of her nurse training. As Maria gradually built up a sense of herself as competent, likeable, and strong, she became more able to leave behind much of her fearfulness and tendency to engage in binge eating. Arva's story: whether to leave a marriage Having been married for five years to a man whose family were prominent members of a leading family within the Asian community in her city; the idea of marital separation and divorce was terrifying for Arva. Although she was no longer willing to accept the physical violence of her husband, she was at the same time unable to envisage that any other life might be open to her if, as she put it, she 'walked away' from her community. Eventually, Arva made an appointment to speak to a counsellor at a domestic violence helpline. Reassured by the acceptance she felt from the counsellor, she agreed to come in for a face-to-face appointment. Initially, Arva was very unsure about whether her counsellor could help her, because it did not seem that the counsellor understood the meaning and implications, within Arva's cultural group, of leaving marriage or publicly accusing a husband of mistreating his wife. Over time, the counsellor developed a sufficient understanding of Arva's experience to allow the counselling to proceed. The counsellor also helped Arva to make contact with an Asian women's support group and a legal advice centre, both of which were helpful to her in providing a broader perspective on her position. Eventually, Arva courageously confronted her husband about his behaviour. To her surprise, he agreed to join her in joint counselling, in which they agreed on some better ways to resolve the conflicts that sometimes arose between them. Maria's story: moving on from abuse At the age of 25, Maria's emotional life and relationships were still dominated by her memories of having been subjected to physical and sexual abuse in her childhood. She found it very hard to trust other people, or to speak up in social situations. For the most part, Maria had decided that the best course of action for survival was to be as invisible as possible. Although at various stages in her life she had tried to talk about her experiences to various doctors, psychiatrists and nurses, she had always felt that they did not really want to know what had happened to her, and were more interested in prescribing various forms of drug treatment to control her anxiety and self-harming behaviour. However, she had made enough progress in her recovery to decide to go to university to train as a nurse. Once started on her course, she found herself confronted by a variety of frightening situations – talking in seminar groups, making new friends, being on placement in busy hospital wards. Maria decided to visit the university student counselling service. This was the first time in her life that she had ready access to any form of psychological therapy. Maria formed a strong relationship with her counsellor, who she occasionally described as 'the mother I never had', and attended counselling weekly throughout the entire three years of her training. Together, Anita's story: dealing with loss Married to Bill for 40 years, Anita was devastated by his sudden death within six months of his retirement. Although Anita felt herself to be fortunate, in enjoying regular 61 Study Guide 1: Counselling and the counselling process contact with her son and daughter and several grandchildren, she increasingly felt that her life was meaningless, and that she would never get over the loss of her beloved Bill. Nine months after his death, she visited her GP, who suggested a course of antidepressants. Unhappy about the idea of possibly becoming dependent on drugs, Anita asked if there were any other alternatives. The GP then referred her to a bereavement counselling service. Anita only attended the counselling on two occasions, and did not find it helpful. When asked afterwards about why she thought that the counselling had not been useful for her, she said: 'he was a nice man, but he just sat and listened, and I felt worse. I couldn’t see any point in it'. when they occurred. He also began to cultivate a subtly different image within the school, and within his own imagination – the 'joker' rather than the 'troublemaker'. Defining counselling The case vignettes presented above give some brief examples of what can happen when someone goes to see a counsellor. But what is counselling? What are the ideas and principles that link together the very different experiences of these counselling clients? How can we understand and define counselling? These are some definitions of 'counselling' formulated by professional bodies and leading figures in the field. … a professional relationship between a trained counsellor and a client… designed to help clients to understand and clarify their views of their lifespace, and to learn to reach their self-determined goals through meaningful, well-informed choices and through resolution of problems of an emotional or interpersonal nature. (Burks and Stefflre 1979: 14) Simon's story: creating a new self-image By the age of 13, Simon had acquired a reputation as a 'difficult' student. Often required to attend detention on the basis of aggressive and uncooperative behaviour, Simon was on the edge of being suspended from school. His form teacher persuaded him that it would do no harm to see the school counsellor. In his first counselling session, Simon sat with his arms crossed, reluctant to talk. However, on the basis that speaking to someone who genuinely seemed interested in his side of things was better than attending maths class, he gradually allowed himself to open up. From Simon's perspective, he felt trapped in an image that other people had of him. Physically strong and mature for his age, and from a family that believed in the value of standing up for yourself, Simon felt that he had made the mistake, early in his career at the school, of challenging one teacher who had (in Simon's eyes) unfairly accused him of a misdemeanour. Ever since that day, it seemed not only other teachers, but also his classmates, seemed to expect him to 'rise to the bait' whenever a teacher reprimanded him. He admitted that he felt 'fed up and stuck' with this pattern, but could not find any way to change it. With the counsellor's help, Simon identified some key trigger situations, and ways of responding differently ... a principled relationship characterised by the application of one or more psychological theories and a recognised set of communication skills, modified by experience, intuition and other interpersonal factors, to clients' intimate concerns, problems or aspirations. (Feltham and Dryden 1993: 6) Counselling and psychotherapy are umbrella terms that cover a range of talking therapies. They are delivered by trained practitioners who work with people over a short or long term to help them bring about effective change or enhance their wellbeing. (British Association for Counselling and Psychotherapy website 2013) Counselling is a professional relationship that empowers diverse individuals, families, and groups to accomplish 62 Reading A mental health, wellness, education, and career goals. (American Counseling Association website 2013) that they have not been able to resolve through their everyday resources, and that has resulted in their exclusion from some aspect of full participation in social life. The concept of 'problem in living' can be understood to refer to any situation or perceived difficulty or impediment that prevents a person from getting on with his or her life. Counselling is not focused on symptom reduction, but on enabling the person to live their life in a way that is most meaningful and satisfying to him or her. These definitions share one important feature in common: they are primarily framed from the point of view of the counsellor. They are definitions that primarily seek to define counselling as ‘something done by a counsellor’. In taking this perspective, these definitions reflect the aim of professional bodies to establish counselling as a professional specialism within contemporary society. However, a profession-centred definition of counselling runs the risk of ignoring the basic fact that counselling is always a two-person (or multiperson) activity, which arises when one person seeks the help of another. In order to reflect a more inclusive meaning of the team ‘counselling’, this book espouses a user-centred definition: 3. Counselling is fundamentally based on conversation, on the capacity of people to 'talk things through' and to generate new possibilities for action through dialogue. 4. Counselling depends on the creation of a relationship between two people, which is sufficiently secure to allow the person seeking help to explore issues that are painful and troubling. Counselling is a purposeful, private conversation arising from the intention of one person (couple or family) to reflect on and resolve a problem in living and the willingness of another person to assist in that endeavour. 5. The person seeking counselling possesses strengths and resources that can be channelled in the service of resolving a problem in living. The act of seeking counselling is not viewed as an indicator of personal deficiency or pathology. The key assumptions that underpin, and are implied by, this definition include: 6. The person in the role of counsellor does not necessarily possess special training or knowledge of psychological theories – counselling is grounded in ordinary human qualities such as a capacity to listen, sensitivity to the experience of others, personal integrity, and resourcefulness in solving the difficulties that arise in everyday life. 1. Counselling is an activity that can only happen if the person seeking help, the client, wants it to happen. Counselling takes place when someone who is troubled invites and allows another person to enter into a particular kind of relationship with them. If a person is not ready to extend this invitation, they may be exposed to the best efforts of expert counsellors for long periods of time, but what will happen will not be counselling. The person seeking counselling is regarded as actively engaged in finding ways of overcoming his or her problems, and as a coparticipant in the counselling process, rather than as a passive recipient of intervention. 7. The person seeking counselling invites another person to provide him or her with time and space characterized by the presence of a number of features that are not readily available in everyday life: permission to speak, respect for difference, confidentiality, and affirmation. 2. A person seeks a counselling relationship when they encounter a 'problem in living' a) Encouragement and permission to speak. Counselling is a place where the person 63 Study Guide 1: Counselling and the counselling process can tell their story, where they are given every encouragement to give voice to aspects of their experience that have previously been silenced, in their own time and their own way, including the expression of feelings and emotion. a) Resolution of the original problem in living. Resolution can include: achieving an understanding or perspective on the problem, arriving at a personal acceptance of the problem or dilemma, and taking action to change the situation in which the problem arose. b) Respect for difference. The counsellor sets aside, as far as they are able, their own position on the issues brought by the client, and his or her needs in the moment, in order to focus as completely as possible on helping the client to articulate and act on his or her personal values and desires. b) Learning. Engagement with counselling may enable the person to acquire new understandings, skills, and strategies that make them better able to handle similar problems in future. c) Social inclusion. Counselling stimulates the energy and capacity of the person as someone who can contribute to the wellbeing of others and the social good. c) Confidentiality. Whatever is discussed is confidential: the counsellor undertakes to refrain from passing on what they have learned from the person to any others in the person's life world. 10. Counselling always exists within a social and cultural context: 'counsellor' and 'client' are social roles, and the ways in which participants make sense of the aims and work of counselling are shaped by the broad cultural and specific community and organizational contexts within which they live. The practice of counselling is informed by awareness and appreciation of social, cultural, historical, and economic factors. The meaning of 'counselling', and the forms of practice associated with this term, continually evolve in response to social and cultural change. d) Affirmation. The counsellor enacts a relationship that is an expression of a set of core values: honesty, integrity, care, belief in the worth and value of individual persons, commitment to dialogue and collaboration, reflexivity, the interdependence of persons, a sense of the common good. Counselling practice is therefore grounded in a distinctive set of values, and moral position, based on respect and affirmation of the worth of the individual person. 11. Counselling is readily accessible. It is a ‘frontline’ service, that is located within the community or organization where the person lives, works or studies. There is minimal ‘gatekeeping’ that needs to be negotiated in order to see a counsellor. 8. Counselling represents an arena for support, reflection, and renewal that is unique within modern societies. Within this arena, the client and counsellor make use of whatever cultural resources come to hand (conversation, ideas, theories, rituals, altered states of consciousness, problem-solving algorithms, discourses, technologies) to achieve a satisfactory resolution of the initial problem in living that initiated the decision to engage in counselling. It can be seen that a user-centred description of counselling highlights a range of factors that are partially hidden in profession-centred definitions. User-centred language characterizes the person seeking counselling as active and resourceful, and purposefully seeking to resolve problems in living, rather than merely a recipient of 'treatment'. It also emphasizes the connection between counselling and the social world of which the 9. The potential outcomes of counselling can be understood as falling into three broad categories: 64 Reading A person is a member. It characterizes counselling as a relationship, a space, or an opportunity that is sought by a troubled person, rather than as any particular form of practice (e.g. two people sitting talking to each other face to face) – thereby inviting creativity and exploration in relation to how this space and opportunity might be constructed. It makes no claim that a professional qualification, or formal knowledge of psychology, is necessary in order to practise counselling – effective counselling can take place both within and outside professionalized networks. How does counselling help? The concept of diversity is central to an understanding of what counselling is about. Counselling is a form of helping that does its best to respect and work with the diverse needs and learning styles of different clients. Because counselling is a frontline service, counsellors are not specialists in one single approach to therapy. Instead, counsellors need to be able to work with whatever and whoever walks through the door, or makes contact by phone or by other means. Effective counsellors are responsive and creative in their capacity to find out what will be most helpful for each individual client. There are many ways in which counselling can help people to move on in their lives: Insight. The acquisition of an understanding of the origins and development of emotional difficulties, leading to an increased capacity to take rational control over feelings and actions. Relating with others. Becoming better able to form and maintain meaningful and satisfying relationships with other people: for example, within the family or workplace. Self-awareness. Becoming more aware of thoughts and feelings that had been blocked off or denied, or developing a more accurate sense of how self is perceived by others. 65 Self-acceptance. The development of a positive attitude towards self, marked by an ability to acknowledge areas of experience that had been the subject of self-criticism and rejection. Self-actualization or individualization. Moving in the direction of fulfilling potential or achieving an integration of previously conflicting parts of self. Enlightenment. Assisting the client to arrive at a higher state of spiritual awakening. Problem-solving. Finding a solution to a specific problem that the client had not been able to resolve alone. Acquiring a general competence in problem-solving. Psychological education. Enabling the client to acquire ideas and techniques with which to understand and control behaviour. Acquisition of social skills. Learning and mastering social and interpersonal skills such as maintenance of eye contact, turntaking in conversations, assertiveness or anger control. Cognitive change. The modification or replacement of irrational beliefs or maladaptive thought patterns associated with self-destructive behaviour. Behaviour change. The modification or replacement of maladaptive or selfdestructive patterns of behaviour. Systematic change. Introducing change into the way in that social systems (e.g. families) operate. Empowerment. Working on skills, awareness and knowledge that will enable the client to take control of his or her own life. Restitution. Helping the client to make amends for previous destructive behaviour. Study Guide 1: Counselling and the counselling process approaches and techniques, but are required to use different titles in response to the demands of the agencies that employ them. For example, traditionally psychotherapy has been the term used in medical settings such as psychiatric units, and counselling the designation for people working in educational settings such as student counselling services. Generativity and social action. Inspiring in the person a desire and capacity to care for others and pass on knowledge (generativity) and to contribute to the collective good through political engagement and community work. Counselling should be flexible enough to make it possible for the client to use the therapeutic relationship as an arena for exploring whatever dimension of life is most relevant to their well-being at that point in time. One of the difficulties with both of these positions is that each of them portrays counselling in a 'little sister' role in relation to psychotherapy. In the 'clear distinction' position, counselling is explicitly described as less effective. In the 'no difference' position, counselling is still placed in a lesser position, by dint of the fact that psychotherapy jobs are higher status and better paid than counselling posts, even when they involve doing equivalent work. What is the difference between counselling and psychotherapy? The degree of similarity and difference between counselling and psychotherapy has been the focus of considerable debate. This issue is made more complex by the fact that, while all English-language societies employ both terms, there are many countries in which only the term 'psychotherapy' is used (e.g. Sweden) and other countries in which 'psychotherapy' is mainly used but where there are ongoing attempts to create a distinction between counselling and psychotherapy (e.g. Germany, where there is a movement to use 'Beratung' as the equivalent to 'counselling'). Within the English language community, two contrasting positions have dominated this debate: A clear distinction can be made between counselling and psychotherapy. The argument here is that, although there is a certain amount of overlap between the theories and methods of counsellors and psychotherapists, and the type of clients that they see, there is nevertheless a fundamental difference between the two, with psychotherapy representing a deeper, more fundamental level of work, over a longer period, usually with more disturbed clients. Counsellors and psychotherapists are basically doing the same kind of work, using identical Many people who work as counsellors are dissatisfied with the 'little sister' image of their professional role because they know that they work with some of the most damaged people in society, and believe that what they do is as effective as any form of psychotherapy. In recent years there has emerged a view that counselling and psychotherapy comprise alternative approaches to responding to the needs of people who experience problems in living. Some key points of contrast between counselling and psychotherapy are summarized in Table 1.1. It is essential to acknowledge that none of the statements of difference in Table 1.1 represent an absolute difference between counselling and psychotherapy. In reality, the domains of counselling and psychotherapy are fragmented and complex, and embrace a multiplicity of forms of practice. It would not be hard to find examples of psychotherapy practice that correspond to characteristics attributed in Table 1.1 to counselling (and vice versa); there is a huge degree of overlap between counselling and psychotherapy. It is best to regard these differences between counselling and psychotherapy as indicative 66 Reading A TABLE 1.1 Similarities and differences between counselling and psychotherapy Psychotherapy Counselling Provides the person with a confidential space in which to explore personal difficulties Provides the person with a confidential space in which to explore personal difficulties Effective practice depends to a great extent on the quality of the client-psychotherapist relationship Effective practice depends to a great extent on the quality of the client-counsellor relationship Self-awareness and personal psychotherapy are valued elements of training and ongoing development Self-awareness and personal therapy are valued elements of training and ongoing development Similarities Differences A wholly professionalized occupation An activity that includes specialist professional workers, but also encompasses paraprofessionals, volunteers, and those whose practice is embedded within other occupational roles Public perception: inaccessible, expensive, middle class Public perception: accessible, free, working class Perception by government/state: given prominent role in mental health services; strongly supported by evidence-based practice policies Perception invisible Conceptualizes the client as an individual with problems in psychological functioning Conceptualizes the client as a person in a social context Training and practice focuses on delivering interventions Training and practice involves not only delivering interventions, but also working with embedded colleagues, and promoting self-help Psychotherapy agencies are separate from the communities within which they are located Counselling agencies are part of their communities – e.g. a student counselling service in a university Treatment may involve the application of interventions defined by a protocol, manual or specific therapy model The helping process typically involves counsellor and client working collaboratively, using methods that may stretch beyond any single protocol or manual Treatment has a theory-derived brand name (e.g. interpersonal therapy, CBT, solutionfocused therapy) Often has a context-derived title (e.g. workplace counselling, bereavement counselling, student counselling) Many psychotherapists have a psychology degree, which functions as a key entrance qualification Counsellors are likely to be drawn from a wide variety of backgrounds; entrance qualification is life experience and maturity rather than any particular academic specialism Predominant focus on the pathology of the person Predominant focus on personal strengths and resources 67 by government/state: largely Study Guide 1: Counselling and the counselling process of a direction of travel that is occurring within the therapy professions, rather than as constituting any kind of fixed map of what is happening now. Nevertheless, a conception of counselling as a distinctive contextually oriented, strengths-based and pragmatic form of practice reflects a trajectory that is clearly visible within the international counselling community. This book seeks to acknowledge the substantial similarities and overlap between counselling and psychotherapy, while at the same time reinforcing the distinctive nature of counselling. years, some counsellors have started to describe their work as life coaching or executive coaching. Coaching is an activity that draws on much of the skill and knowledge of counselling, but is focused on the promotion of positive effectiveness and achievement, rather than on the amelioration of problems. Finally, there is a large degree of overlap between the use of the terms ‘counselling’ and ‘psychotherapy’, as discussed in the preceding section of this chapter. There also exists a wide diversity in counselling practice, with counselling being delivered through one-to-one contact, in groups, with couples and families, over the telephone and Internet, and through written materials such as books and self-help manuals. Counselling is practised in a range of different settings, and offered to a wide array of client groups. Where can I find a counsellor? There are several occupational titles that refer to people who are practising counselling. A term that is sometimes used is counselling psychologist. This refers to a counsellor who has initial training in psychology, and whose work is specifically informed by psychological methods and models. There are also several labels that refer to counsellors who work with particular client groups: for example, mental health counsellor, marriage/couple counsellor, bereavement counsellor or student counsellor. These practitioners possess specialist training and expertise in their particular field in addition to general counselling training. There are also many instances where counselling is offered in the context of a relationship that is primarily focused on other, non-counselling concerns. For example, a student may use a teacher as a person with whom it is safe to share worries and anxieties. A community nurse may visit a home to give medical care to a patient who is terminally ill, but finds herself also providing emotional support. In these situations it seems appropriate to describe what is happening as embedded counselling (McLeod and McLeod, 2011). Embedded counselling is, or can be, an aspect of a wide range of professional roles: clergy, teaching, health, social work and community work, legal and justice work, personnel, human resources and management, and much else. Embedded counselling also takes place in a variety of peer self-help networks, such as Alcoholics Anonymous and Weightwatchers. In recent This diversity of theory and practice can be attributed to the fact that counselling emerged and grew during the twentieth century in response to a mix of cultural, economic and social forces. In essence, because it is targeted at individuals and small groups, and focuses on the personal needs of each client, counselling represents a highly flexible means of responding to societal problems. For example, many counselling agencies are funded by, or attached to, organizations that have a primary task of providing medical and health care. These range from mental health/psychiatric settings, which typically deal with highly disturbed or damaged clients, through to counselling available in primary care settings, such as GP surgeries, and from community nurses. There has also been a growth in specialist counselling directed towards people with particular medical conditions such as AIDS, cancer and various genetic disorders. Counselling has also played an important role in many centres and clinics offering alternative or complementary health approaches. One of the primary cultural locations for counselling and psychotherapy can therefore be seen to be alongside medicine. Even when counsellors and 68 Reading A counselling agencies work independently of medical organizations, they will frequently establish some form of liaison with medical and psychiatric services, to enable referral of clients who may require medical or nursing care. These areas of counselling practice reflect the increasing medicalization of social life (Turner 1995), and the pressure to create a space for personal contact and relationship within technologically driven health care. cessation. The social role of the counsellor can be seen particularly clearly in this type of work. In some areas of addiction counselling, such as with hard drug users, counsellors operate alongside a set of powerful legal constraints and moral judgements. The possession and use of heroin, for example, is seen by most people as morally wrong, and has been made a criminal offence. The counsellor working with a heroin addict, therefore is not merely exploring ways of living more satisfyingly and resourcefully, but is mediating between competing social definitions of what an acceptable 'way of living' entails. In other fields of addiction counselling, such as food, alcohol and cigarette abuse, the behaviour in question is heavily reinforced by advertising paid for by the slimming, drink and tobacco industries. The incidence of alcohol-and-smokingrelated diseases would be more effectively reduced by tax increases than by increases in the number of counsellors, an insight that raises questions about the role of counselling in relation to other means of control of behaviour. Counselling also has a place in the world of work. A variety of counselling agencies exist for the purpose of helping people through difficulties, dilemmas or anxieties concerning their work role. These agencies include vocational guidance, student counselling services and employee assistance programmes or workplace counselling provided by large organizations in industry and the public sector. Whether the work role is that of executive, postal worker or college student, counsellors are able to offer help with stress and anxiety arising from the work, coping with change and making career decisions. A number of counselling agencies have evolved to meet the needs of people who experience traumatic or sudden interruptions to their life development and social roles. Prominent among these are agencies and organizations offering counselling in such areas as marital breakdown, rape and bereavement. The work of the counsellor in these agencies can very clearly be seen as rising from social problems. For example, changing social perceptions of marriage, redefinitions of male and female roles, new patterns of marriage and family life, and legislation making divorce more available represent major social and cultural changes of the past century. Counselling provides a way of helping individuals to negotiate this changing social landscape. The significance of paying attention to the context within which counselling takes place arises from an appreciation that counselling is not merely a process of individual learning. It is also a social activity that has a social meaning. Often, people turn to counselling at a point of transition, such as the transition from child to adult, married to divorced, addict to straight, or when they are struggling to adapt to social institutions. Within these contexts, counsellors are rarely managers or executives who hold power in colleges, businesses or communities. Counsellors, instead, have a more 'liminal' role, being employed at the edge of these institutions to deal with those in danger of falling off or falling out. A further field of counselling activity lies in the area of addictions. There exists a range of counselling approaches developed to help people with problems related to drug and alcohol abuse, food addiction and smoking The aim of this chapter has been to provide an image of the complex mosaic of contemporary counselling practice. From the point of view of the user or client, counselling can be understood as a relationship and a Conclusions 69 Study Guide 1: Counselling and the counselling process conversational space that enables problems in living to be explored and resolved. Counselling is a flexible form of helping, that respects diversity and strives to understand problems from the point of view of the client, rather than trying to fit the client to a preexisting diagnostic system. At its best, counselling is a frontline, community-based service that is readily accessible to people who need it. As a result, counselling is available in a wide range of community settings. The implications of this image of counselling, and the ways in which it has been interpreted and articulated by practitioners and organizations, are explored in the following chapters. advisory services. In Britain, the Standing Council for the Advancement of Counselling, which was later to become the British Association for Counselling was inaugurated in 1971, by a network of people who were primarily based in social services, social work and the voluntary sector. The precursors to the formation of these organizations can be understood in terms of a sense of crisis within society, or ‘moral panic’, around various areas of social life. In effect, what happened was that there was a sense of unease around some aspect of the breakdown of social order, or the identification of groups of individuals who were being unfairly treated in some way. These crises were characterized by widespread publicity about the problem, debate in newspapers and magazines, and efforts to bring about political or legislative change. At some point in this process, someone would have the idea that the best means of helping was to treat each person needing assistance as an individual, and that the most effective way to proceed was to sit down with that individual, discuss the matter, and find the best way forward for that person in terms of his or her unique needs and circumstances. The idea of ‘counselling’ appears to have emerged more or less simultaneously, in many different fields of social action, in this manner. PART II: The emergence of counselling The history of psychotherapy has been much more fully documented than the history of counselling. Counselling, as a distinct profession came of age only in the 1940s. One of the public markers of the emergence of counselling at that time was that Carl Rogers, in the face of opposition from the medical profession to the idea that anyone without medical training could call himself a ‘psychotherapist’, began to use the term ‘counselling and psychotherapy’ to describe his approach (Rogers, 1942). Although in many respects counselling, both then and now, can be seen as an extension of psychotherapy, a parallel activity or even a means of ‘marketing’ psychotherapy to a new groups of consumers, there are also at least two important historical strands that differentiate counselling from psychotherapy: involvement in the educational system and the role of the voluntary sector. The American Personnel and Guidance Association, which was later to become the American Counselling Association was formed in 1952, through the merger of a number of vocational guidance professional groups that were already well established by that time. The membership of American Personnel and Guidance Association consisted of counsellors who worked in schools, colleges, and career Probably the first recorded example of this kind of ‘invention of counselling’ was in the work of American social reformer Frank Parsons (1854-1908). In his earlier years, Parsons had been employed as an engineer, lawyer and writer, before turning to lecturing at Boston University. He was well known, internationally, for his writing and lecturing that argued against the uncontrolled capitalism of the time, and proposed that it should be replaced by a philosophy of mutualism – ‘the replacement of competition by cooperation, and lust for money by concern for humanity’ (Gummere, 1988: 403). He campaigned for votes for women, and public ownership of key industries. In the final years of his life, Parsons came to be 70 Reading A particularly interested in the issue of helping young people to be matched with jobs that were right for them. He established a ‘Vocation Bureau’ in an immigrant district of Boston, where young people were interviewed and assessed, provided with information about possible career choices, and provided with opportunities to explore their feelings around the work they would like to do. The philosophy of the Bureau was clearly grounded in what we now consider to be a counselling approach: ‘no person shall decide for another what occupation he should choose, but it is possible to help him to approach the problem that he shall come to a wise conclusion for himself’ (Parsons, 1909: 4). The Vocation Bureau operated as an example and catalyst for the expansion of counselling provision in schools and vocational guidance services, throughout the USA (O’Brien 2001). Counselling of various kinds came to be offered within the school and college systems in the 1920s and 1930s, as career guidance and also as a service for young people who were having difficulties adjusting to the demands of school or college life. Psychological testing and assessment was bound up with these activities, but there was always an element of discussion or interpretation of the student’s problems or test results (Whiteley 1984). a response to perceived social breakdown and crisis in areas such as rape, bereavement, gay and lesbian issues and child abuse. As with the National Marriage Guidance Council, many of these initiatives were led by Church groups. For example, in Scotland, many counselling agencies owe their existence to the pioneering work of the Board of Social Responsibility of the Church of Scotland. A further early example of the use of a counselling approach in response to a social problem can be found in the employee counselling scheme introduced in 1936 in the Hawthorne plant of the Western Electric manufacturing company (Dickson 1945; Dickson and Roethlisberger 1966; Levinson 1956; Wilensky and Wilensky 1951). In this project, counsellors were available to employees on the shop floor, to talk about any issues (both work based and personal) that might be affecting their capacity to do their job. The rationale for the provision of counselling was that the management of the company acknowledged the pressures of working on a production line, and sought to maintain workforce well-being both as a welfare response, and also as a means of maximizing productivity and reducing staff turnover. The acceptability and popularity of this service on the part of workers, was documented in an evaluation of the scheme by Dickson and Roethlisberger (1966), which found that over a three-month period, 36 per cent of the workforce made use of counselling, with 10 per cent of those who used it reporting that it had been very helpful. In Britain, counselling had strong roots in the voluntary sector. For example, the largest single counselling agency in Britain, the National Marriage Guidance Council (now RELATE), dates back to 1938, when a clergyman, Dr Herbert Gray, mobilized the efforts of people who were concerned about the threat to marriage caused by modern life (Tyndall 1985). The additional threat to married life introduced by World War II led to the formal establishment of the Marriage Guidance Council in 1942. A comprehensive historical analysis of the growth of the National Marriage Guidance Council, in response to societal and governmental alarm about divorce rates and marital breakdown, has been published by Lewis et al. (1992). Since that time, many other groups of volunteers have set up counselling services as These examples of critical moments in the emergence of counselling illustrate the existence of a distinct historical tradition, which has primarily arisen from a social action perspective rather than an individual pathology orientation. Although there has been much mutual interaction and influence across counselling-psychotherapy professional communities, from a historical vantage point it is possible to see that they are each culturally positioned in somewhat different territories. 71 Study Guide 1: Counselling and the counselling process From these beginnings, counselling expanded rapidly in the latter half of the twentieth century, in terms of the membership of counselling professional bodies, the range, scope and number of counselling agencies and the ease of public access to counselling. There would appear to be a number of factors responsible for this growth: The success of the earliest counselling services, in the areas of education, marital and bereavement work, inspired groups of people to develop counselling services for a wide array of other social issues, such as suicide prevention, domestic abuse, sexual violence, drug and alcohol abuse, disability and affirmation of sexual orientation. We live in a fragmented society, in which there are many people who lack emotional and social support systems that might assist them in coping with stressful problems in living – counselling fulfils a vital role in society, as a means of assisting individuals to effectively negotiate transition points in their lives. Counselling agencies are generally located within the communities of those whom they serve and are networked with other caring organizations – members of the public usually know about the counselling that is available in their community, and do not feel stigmatized in making use of it. Counselling regularly receives publicity in the media, most of which is positive. The media image of counselling is low-key and reassuring, in contrast to, for example, the cartoon representation of the psychoanalyst. The legitimacy of counselling has never relied on research evidence or government policy initiatives, but instead is based on word of mouth recommendation from users. Caring and ‘people’ professions, such as nursing, medicine, teaching and social work, which had previously performed a quasi-counselling role, were financially and managerially squeezed during the 1970s and 1980s. Members of these professions no longer have time to listen to their clients. Many of them have sought training as counsellors and have created specialist counselling roles within their organizations, as a way of preserving the quality of contact with clients. Many thousands of people who work in caring professions have received training in counselling skills, as part of their basic professional education, and use these skills within an ‘embedded counselling’ role. There are also a large number of part-time volunteer counsellors, who combine some counselling work alongside other occupational and family responsibilities. All this creates an enormous reservoir of awareness within society of counselling methods (such as empathic listening) and values (such as non-judgemental acceptance). There is an entrepreneurial spirit in many counsellors, who will actively sell their services to new groups of consumers. For example, any human resource or occupational health director of a large company will have a filing cabinet full of brochures from counsellors and counselling agencies eager to provide employee counselling services. Counselling is a highly diverse activity which is delivered in a broad range of contexts (voluntary / not-for-profit, statutory, private practice, social care, health, education); this diversity has allowed counselling to continue to expand at times when funding pressures might have resulted in cuts in provision to any one sector. The emergence of counselling needs to be understood in relation to the parallel growth 72 Reading A of psychotherapy. There have been many practitioners, from Carl Rogers onwards who have spanned the counselling-psychotherapy divide. The majority of counselling agencies drew heavily on ideas from psychotherapy, to shape their training, supervision and practice policies. In the UK, and other countries, there are organizations, such as the British Association for Counselling and Psychotherapy, that seek to emphasize the convergence of the two professional traditions and communities. Nevertheless, counselling has retained its own identity as a distinctive practice with its own history. 73 74 Reading B Structuring Work with Clients Ian Horton In The Sage Handbook of Counselling and Psychotherapy (3rd ed.) Colin Feltham and Ian Horton (eds.) Sage Publications London, UK, 2012 PGS 122 – 128 75 Study Guide 1: Counselling and the counselling process STRUCTURING CLIENTS WORK WITH Preparatory Phase Many practitioners believe that the therapeutic relationship actually begins before any face-to-face contact with clients. Several factors may influence both the client’s and the therapist’s expectations of each other and therefore the beginning of their relationship and the subsequent development of the therapeutic process. For some counsellors or psychotherapists, the normal procedure may be for a senior therapist to conduct an intake assessment, followed by allocation to a suitable therapist – a process which in itself may structure expectations and norms. This chapter examines the structure and process of counselling and psychotherapy. In places it overlaps with topics in the following chapters, but the emphasis here is on therapeutic phases. The assumption is made that, irrespective of theoretical orientation, it is possible to conceptualize the therapeutic process in terms of framework of broadly defined phases or stages. Each phase is characterized by particular process goals or tasks that need to be achieved as a prerequisite of moving forward to the next phase (Beitman, 1990; Egan, 2010; McLeod, 2003). As a structural overview of the developmental process, the framework provides therapists with a sense of grounding and direction. But it is only a cognitive map and as such cannot reflect the actual experience or dynamics of a process that seldom, if ever, follows a straightforward linear progression through discrete and clearly defined phases. As the relationship between therapist and client develops, new issues may emerge, goals are evaluated and often redefined, and earlier phase-related tasks may be revisited and worked on more deeply. It is a fluid, multidimensional and complex process. Prior Knowledge The therapist may have a referral letter or report containing detailed information about the client and her or his presenting problem and history. Casual comments made by the receptionist or other people working in the agency or service setting may unwittingly influence the therapist’s expectations of the client. Clients themselves will often come to therapy with preconceptions about counselling or psychotherapy and project them on to the particular therapist. Previous experience of some form of psychological or psychiatric help (a phenomenon that is increasing), or accounts of the experiences of others, may similarly influence the client’s expectations. The client may have heard something about the reputations of the particular therapist or agency. A simple generic model of the four phases of therapy – preparatory, beginning, middle and ending – is used here as a heuristic framework for examining the typical structure, process and procedures of counselling and psychotherapy. The therapist’s own theoretical orientation will largely determine the relative emphasis and importance placed on the various aspects of the four-phase model. Some psychotherapists regard initial and ongoing frame management as the main, if not the only, kind of legitimate structuring (e.g. Smith, 1991) and many psychoanalytic therapists are unconcerned with temporal and outcome issues. On the other hand, some forms of brief therapy are highly structured in terms of temporal phase. Introductory Leaflet Many agencies or therapists produce information leaflets to give to potential clients. The purpose is to inform the client about the conditions and procedures to follow and what to expect when coming for counselling or psychotherapy. The leaflet, read carefully by some potential clients and probably ignored by others, is nevertheless an opportunity to help establish positive and accurate expectations of what therapy is about. An information leaflet for clients will normally contain the following information: 76 Reading B Letter of Appointment In some situations the letter offering a first appointment may be the first contact with the client, who, even from this limited source of information, may begin to develop some impression of the therapist and the service offered. Therapists may want to convey a balance of warmth and professional formality in what and how they write to clients. Letters, usually typed or neatly handwritten on headed A4 notepaper, would normally include the information about the location, date, time and duration of the first session, as well as the contact telephone number and, if appropriate, how and when the client should confirm acceptance of the appointment. Some examples of letters to clients can be found in Chapter 3.8 on ancillary skills in this volume. some explanation of what counselling and/or psychotherapy is about examples of kinds of problems people might come with and how therapy can help background information about the particular agency or service offered qualifications, experience and professional affiliation of the therapists providing the service how to make an appointment fees and how these are paid cancellation procedures, fee implications and period of notice required typical duration and frequency of sessions and length of contract theoretical orientation and approach to counselling or psychotherapy where the counselling or therapy will take place, postal address, name and telephone number of therapist or contact person. Preparation Before the Client Arrives Few if any therapists would disagree that it is absolutely essential to arrive on time and before the client arrives. Beginning practitioners often like to arrive early to check the room (see Chapter 3.8), read through the referral report or their case notes, and maximize their level of ‘free attention’. First Telephone Call Often, the first direct contact between client and therapist is through a telephone call. Many people do not find it easy to be a client and have to admit to others (and to themselves) that they have a problem they cannot cope with. Some people agonize for some time before plucking up enough courage to make the initial telephone call. The client may be upset, diffident about making the call or sceptical about counselling or psychotherapy. The reception he or she receives, what the therapist says and how it is said, may influence the caller’s feelings and attitudes. The therapist may be very busy or tired, but if he or she is able to offer a place for an initial appointment, this is the first opportunity to start building rapport by communicating some degree of warmth and concern perhaps by responding to callers by mirroring the way they speak. In one sense the therapeutic relationship starts at this point. The client needs to feel accepted, welcomed and understood. What happens next and what is being offered need to be explained simply and clearly. Practitioners vary in their attitude towards referrers’ reports. Some like to study the reports carefully, noting issues to explore with the client or at least to hold as ‘silent hypotheses’. Some agencies adopt a policy of asking clients to complete a pre-interview questionnaire on background history and personal details. Other practitioners want to meet the client without being influenced by the apparent facts and opinions provided by the referrer. They deliberately do not read the referral letter until after their first meeting with the client. The risk with this procedure is that the referrer might mention some critical issues which the therapist really does need to be aware of before meeting the client – for example, a record of frequent violent or aggressive behaviour or recent suicide attempts. The key issue is for the therapist to be aware of her or his assumptions or inferences drawn from what can sometimes 77 Study Guide 1: Counselling and the counselling process be highly subjective and often dated information about the client. psychotherapists are seen as powerful people, and clients initially feeling overwhelmed are unlikely to correct the therapist’s pronunciation of their name or the mode of address and may feel put down or feel that the therapist does not really care about them as individuals. Immediately prior to the expected arrival of the client, some therapists follow deliberate procedures to enable them to relax and focus attention on what they are about to do. Simple physical relaxation or breathing exercises or just sitting in silence for a few minutes can help the therapist to prepare mentally. Another concern for some therapists is whether to leave it to clients to decide where to sit or, more conventionally, whether to indicate where the client should sit. To leave it to the client may, albeit in a small way, helps the client to feel more equal in an inevitably unequal relationship, but it can mean that the client has yet another unfamiliar decision to make at a time when they are already feeling anxious about what is going to happen. Beginning Phase The first face-to-face meeting with the client sows the seeds of attraction, uncertainty or dislike and the beginning of the therapist’s assessment of the client. People are often unaware of the source of their feelings or immediate reactions to others, although counsellors and therapists are trained to be aware of the way in which they prematurely interpret what they notice about the dress and demeanour of others, or may project feelings or attitudes derived from previous relationships or situations on to their clients. But of course this is a two-way process; clients will have feelings too and will make assumptions about the therapist on their first meeting. Both parties will be tentatively sizing the other up. Introduction ‘How can I help you?’, ‘What brings you here?’, ‘We have 50 minutes together, how would you like to use the time?’ are some of the ways in which therapists encourage the client to start talking as soon as possible. Some psychoanalytic therapists think it is important to say nothing from the outset. However, other practitioners prefer to start by setting the scene, being aware that once some clients launch into telling their story it is hard to stop them, while other more reticent clients appreciate some time to relax into their new surroundings with a stranger and have little or no idea how the therapist might be able to help them or how to use the time. There is some ‘collective wisdom’, if not clear research evidence, that indicates a strong correlation or association between therapist and client of the purpose of what they are doing together and how they are going to try to achieve it. This shared understanding is the basis of an effective working or therapeutic alliance. So some therapists prefer to start by saying something like: ‘the purpose of our first meeting today is for us to get to know each other and for me to begin to understand something of the problems or issues that bring you here. At the end of the hour we may be in a position to decide whether we want to continue to work together and we will discuss the necessary Initial Greeting and Seating Practitioners vary in the degree of formality with which they greet their clients. Many do so warmly, but wait for the client to indicate tentatively whether they expect to shake hands. It is important to get the client’s name correct and it is useful to become familiar with the naming conventions of different cultures. If in doubt, it is an idea to ask clients how they wish to be addressed or at least initially to adopt a more formal manner of address, leaving until later the choice to become more familiar. Some culturally different names may be difficult for therapists to pronounce. Again it would be appropriate for the therapist to ask the client how to pronounce her or his name. This at least communicates that it matters to the therapist to get the client’s name right. Especially in some cultures, counsellors and 78 Reading B arrangements.’ Some clients may have been sent by their GP or persuaded by a friend to come and may be sceptical about the value of counselling or psychotherapy. In this situation the task is to try to establish whether or not there is a basis for working together and the therapist may suggest to the client that they leave it to a subsequent session before formally contracting to work with the client. This would give the therapist an opportunity to consult her or his clinical supervisor before seeing the client again. what therapy is about, the rules of therapist and client, and what is going to happen. Beginning therapists may find it a very useful exercise to prepare and rehearse the actual words they may use to define or explain counselling or psychotherapy to clients. The whole idea of therapy as an approach to problem solving or self-development is culture bound. Seeking help with psychological problems from someone outside the family is alien to some cultures, and clients may need time to discuss and assimilate the implications and consequences of doing so. Similarly, counselling and psychotherapy goals are culture bound. For example, concepts such as self-awareness or self-actualization and the emphasis on individualism may be inappropriate as explicitly stated goals when working with some clients in cross-cultural-settings. Therapist’s Agenda Theoretical orientation, personal preference and style, and agency setting and organizational constraints or procedures are some of the factors that may determine the way in which the first session is structured and managed. While most therapists tend to adopt a similar way of working with all their clients, some vary what they do according to perceived client needs and expectations. The style and approach differ enormously between therapists – even those of the same orientation – and vary along a continuum from formal and highly structured to open, flexible and very much client led. At some point in the first (few) session(s) it is usually helpful for the therapist to say something about the ground rules or boundaries of counselling or psychotherapy. Issues about privacy, confidentiality and its limits, the length of sessions and time boundaries may need to be explained and discussed. If the therapist is culturally close to the client, some clients may feel an instant rapport and trust, but others may fear a loss of confidentiality and feel as if they risk what they say being known by everyone in their cultural community. The therapist may need to reassure the client that he or she respects confidence and that therapy is in no way compatible with socializing. Some clients may disclose something critical near the end of the session, in what feels like the safety of the session ending; other clients may be unfamiliar with the strict timekeeping of middleclass Western practice and be left feeling resentful when invited by the therapist or raise the issue again in their next session. Nevertheless, whether it is explicit or not, most practitioners will have a similar agenda for the first few sessions or for the beginning phase of their work with clients. This agenda may typically include the following process goals or tasks, irrespective of whether they are achieved through listening to the client’s story, intervening as appropriate as the story gradually unfolds, or asking questions in a more structured interview. Some therapists listen for or deliberately ask about the client’s expectations and previous experiences of counselling or psychotherapy. This information will help the therapist to assess the client’s needs and level of readiness and to know how best to begin to facilitate a strong therapeutic alliance. Facilitating client self-disclosure is the primary task of the beginning phase of therapy. Talking about themselves and their problems is after all exactly what the client has come for. The therapist will listen to the For clients for whom counselling or psychotherapy is a truly new and unfamiliar experience, the therapist may need to explain 79 Study Guide 1: Counselling and the counselling process client’s story and explore the client’s social and cultural background, history and experiences, the onset of the problem, current stresses and issues, coping behaviours and motivations. This will enable both the therapist and the client to begin building a picture of the problem and to consider if and how therapy might help. Some therapists start to develop a formal assessment or clinical formulation of the client’s present problem and, from this, an initial therapeutic plan or possible therapeutic goals and approach to working with the particular client. The business contract is important and few therapists disagree that it needs to be concrete and explicit. The business contract concerns such things as the duration, frequency, number, day and starting time of sessions, fees and how they are to be paid, procedures for the cancellation of sessions, and fees for missed sessions. Some therapists like to give this information in written form and include the date and time of the next appointment. Comprehensive details of contracting from the perspectives of different theoretical orientations are given in Sills (2006). At this point, usually at the end of the first session, therapists need to make a decision. Basically, there are four options: Ending the first session is an opportunity to clarify administrative details and handle any questions the client may still have about the therapy, before confirming the next appointment and parting. to offer counselling or psychotherapy to offer to refer the client to another therapist or agency not to offer counselling or psychotherapy if the therapist thinks it would be inappropriate or not useful to the particular client at this time to defer the decision to contract until a later session. Summary: Beginning Phase Process Goals The beginning phase may last for one, 20 or more sessions depending on the nature of the contract, the theoretical orientation and the progress made. The process goals or tasks that need to be accomplished are summarized here: Therapists approach contracting with clients with varying degrees of formality, clarity and explicitness (Sills, 2006). It is possible to identify two types of contracting: therapeutic and business contracts. The first is concerned with negotiating and identifying with the client the sort of desired outcomes the therapy might achieve, and the initial focus or aspect of the problem that the therapist and client intend to work on together and how they might approach this. The nature of the therapeutic contract and whether it is stated explicitly and even written down will depend very much on the therapist’s theoretical orientation and personal preference. Some therapists assume that the therapeutic contract is part of the client’s induction in to therapy and a largely unspoken yet integral part of the gradually evolving therapeutic process. 80 Build the relationship, establish rapport and an effective working alliance, clarify boundaries, conditions and the client’s role, and work towards developing mutual aims about the work of therapy. Facilitate client self-disclosure; identify the client’s presenting problem through understanding the client’s worldview and experiences, exploring antecedents, precipitating events, social/cultural context and assessment of client strengths and resources. The therapist may begin to develop a tentative assessment of the nature, origins and ramifications of the client’s problem(s) in a way that suggests a possible target for change. In some psychodynamic work the early fostering of a positive transference might be a key task. Reading B strengths and ways of coping, working towards new perspectives, deeper selfawareness or understanding, and learning different ways of thinking, feeling and/or behaving. Negotiate therapeutic and business contracts, and monitor and review progress. Middle Phase This is typically the longest phase in counselling or psychotherapy. It is the work phase in which conflicts and problems are more clearly defined and worked through. It is within this phase that the biggest variation in practice exists. What therapists are trying to achieve and how they approach the work are largely determined by their theoretical orientation and how they explain the origin and maintenance of psychological problems and the principles and process of change. Nevertheless, at least in broad terms, it is possible to identify the kinds of process goals or tasks generally associated with this phase. Therapists vary in how and whether they explicitly monitor progress. Some formally contract to hold regular review sessions with their clients; others rely solely on clinical supervision, personal reflection and writing case notes to review progress, while some believe in suspending the notion of anxiety about progress altogether. Reviewing Some practitioners strongly advocate the need to include regular review sessions in their contract with clients, so that every five weeks or so the client will know that at least part of the session will be spent reviewing progress. Other therapists will review only informally, whenever it seems appropriate or when something comes up, or alternatively only when the work has reached an impasse, when things feel stuck and little, if any, progress is being made. However, clients are entitled to a competently delivered service that is periodically reviewed (BACP, 2002). Summary: Middle Phase Process Goals The aspect of the counselling or psychotherapy process most strongly associated with successful outcome is the quality of the therapeutic relationship and strength of the working alliance. In the middle phase work continues to maintain and develop further the relationship between therapist and client. Where appropriate and consistent with the therapist’s theoretical orientation, the dynamics of the relationship, or what is going on within both therapist and client and between them, may be used as a basis for learning and motivation. The dynamics of the relationship between therapist and client can often provide a ‘window’ on the client’s presenting problem and any hidden conflicts or issues. The arguments for explicitly monitoring progress with the client include: In the middle phase the therapist is concerned with facilitating learning and change, congruent with the identified therapeutic goals and theoretical assumptions about change. It is also the phase in which sometimes unexpected memories, discoveries, obstacles, crises and ambivalence or defences may arise. The process goals of this phase may involve searching for patterns and key themes in the client’s experiences and behaviours, affirming and, where possible and appropriate, using the client’s to check out the therapist’s assumption about how things are going and if necessary use the opportunity to make changes or improve ways of working to reinforce learning and change or the conditions for change to share power with the client by involving the client in evaluating progress and to help re-establish that the therapist is working with the client rather than for, or doing something to, the client Arguments against any formal review sessions might be that they interrupt the whole therapeutic process and that any impasse, stuckness or resistance is better worked through as a natural part of the therapy. Review sessions could be seen as a 81 Study Guide 1: Counselling and the counselling process way of avoiding or even perpetuating resistance to change and potentially damaging the transference relationship and may be misinterpreted by some clients as a review of them. Review Session Structure Review sessions will be conducted with varying degrees of structure and formality. In standard long-term psychoanalysis psychotherapy, any form of review may be discouraged, while some therapists adopt the practice of asking at each session ‘what the client wants’, ‘how it went’, etc. however, a full review agenda would usually involve discussing the following aspects: Client and therapist expectations and understanding of what it is they are trying to achieve together. Therapeutic goals: what has been achieved? What changes have occurred? What evidence is there of any change? Client’s experience of the therapeutic process and relationship: what has the client found helpful, unhelpful or difficult? What problems, if any, do the therapist and client have in working together? Negotiate ways forward. Review and confirm, and if necessary, revise the therapeutic goals or focus of the work, and discuss possible alternative ways of working. Review the business contract, and recontract for a further period before the next review session. For some clients, separation and loss may have been a key theme or conflict in their work with the therapist. Ending therapy may mean a reworking of earlier loss or celebration of a new beginning. Ending may be more critical in some types of time-limited contracts and therapists need to pay attention to managing effectively client resources and deficits. Summary: Ending Phase Process Goals Most therapists will pay attention to some or all of the following tasks in working towards a satisfactory ending with their clients: Ending Phase The ending phase of therapy may represent a real or symbolic loss for many clients. It can provide a potent force in changing a client’s frame of mind. In thinking about how best to orchestrate endings or the termination of counselling or psychotherapy, therapists will need to have views, although not necessarily clearly articulated views, on several issues (Davis, 2008; Leigh, 1998): to prepare for the ending? Some therapists discuss the ending at the beginning of their work with clients; others use a ‘countdown’ system to remind clients about how many sessions they have had and how many remain. Who decides when therapy should end? Is it decided by the client, by the therapist or by mutual agreement? How rigid is the decision about ending? Will the therapist adhere strictly to the agreed ending date? This decision is usually linked to the nature of the therapeutic goals, type of contract and sometimes negotiated or otherwise implicit completion criteria. Clearly, therapists need to be aware of what, if any, are the circumstances that justify an extension and how flexible they can be and what the ramifications are. What may be the special existential or development needs of the particular client around loss and ending? How explicit is the issue of ending therapy with clients? How important is it 82 seeking resolution of the client’s issues around ending exploring ways of consolidating learning and change through helping clients to apply and assimilate change into new ways of being or living and through identifying obstacles and ways of sustaining and expanding change evaluating the outcomes of therapy and the effectiveness (or otherwise) of the therapeutic process and relationship Reading B A high percentage of counselling and psychotherapy contracts end by default rather than by design. That is, clients may just stop coming for therapy, sometimes not even letting the therapist know and not replying to the therapist’s letter. Incomplete ending by default can haunt therapists for some time. It is all too easy to slip into imagining all sorts of circumstances or reasons, including the therapist’s own mistakes or incompetence, for clients failing to attend to the end of the negotiated contract or agreed period of therapy. These things are best worked through in clinical supervision. However, most therapists will have the opportunity to formally complete their ending work with a client. Ending Session Structure Ending can be viewed as a process in itself. The aim is to help clients integrate their views of what has happened and reinforce the positive aspects of the experience. The intention is to enable clients to sustain any change. There are five areas that can be usefully explored with clients at the end of counselling or psychotherapy: What has been achieved? What changes have occurred or are anticipated by both client and therapist? Were the goals met? What still needs to be achieved? Is it possible to anticipate any return of symptoms in particular circumstances? Will the client be able to cope with old problems using the new ‘solutions’ or ways of coping learned in therapy? Why has change happened? How does the client attribute cause or responsibility for change? The client’s story about therapy is the best predictor of whether useful changes will last. Clients need to know the ways that they contributed to or are responsible for any change and the quality of the relationship. What may happen in the future? Is it possible to anticipate any stresses or ‘rough spots’? What resources are available for support? Sometimes it is helpful to try to 83 identify signs or indicators of the need to start therapy again. Will the therapist offer a one-off follow-up in say six to eight weeks, or invite the client to make contact again if necessary? What possible messages might that give to the client? What seems important is that a ‘good ending’ will help to ensure that clients will have positive feelings about the prospect of returning to therapy – and see it not as a failure, but as a normal occurrence in developmental change. What has been the nature of the therapy relationship? This can be threatening to the therapist, and some see it as irrelevant to identifying what qualities were helpful and/or difficult in the relationship. The client may be encouraged to identify what has been learned from the therapy relationship that may help the client in other relationships. Study Guide 1: Counselling and the counselling process 84 Reading C Learning Counseling and Problem-Solving Skills Leslie E. Borck and Stephen B. Fawcett Routledge New York, NY, 2013 PART I: PGS 61 – 68 PART II: PGS 70 – 75 85 Study Guide 1: Counselling and the counselling process PART I: HOW TO HELP A CLIENT SOLVE A PROBLEM CLIENT: My son has no friends in school. HELPER: Uh-huh. CLIENT: I tried talking to his teacher about it, but that didn’t do any good. (Sighs and pauses) Clients and friends come to a helper because they are having a problem. Sometimes they simply need to talk about the problem situation. In these cases, the counselor’s responsibility is to be a good listener and help the client ventilate his or her feelings. The skills of listening actively, reflecting feelings, and open-ended question-asking will be very effective in helping a person do this. HELPER: You sound very depressed about the whole thing. CLIENT: I am. HELPER: Could you tell me more about it? CLIENT: Sure. He’s in the fourth grade, and has no friends. He’s very quiet anyway, but I understand he says very little in school. At home he has his sister and brothers to play with, but I’m worried because he is always by himself at school. At other times, people need help solving a problem. In these cases, the counselor’s responsibility is to help the client understand the problem situation, think of alternative solutions, evaluate each, and select the best one. HELPER: Uh-huh. CLIENT: I don’t know if it has gotten worse or anything. I just think he’s getting to the age where he needs to have friends his own age. I mean, other children all play with children their own age, don’t they? This chapter is designed to teach problemsolving skills that enable helpers to assist clients in reaching satisfactory decisions. It is important that the counselor assist the client in solving problems, not solve problems for the client. By demonstrating a systematic problem-solving approach, the helper provides an example of how the client might solve his or her problems in the future. HELPER: Sounds like you’re worried that the problem might get worse if you don’t do something about it soon. CLIENT: Right. I probably should have done something about it a long time ago. HELPER: It seems like you have some feelings about that. Address the client by name throughout the problem-solving process. This helps to encourage the client to be honest and open. CLIENT: I do, but that gets into a whole different story. When to Use HELPER: Would you like to talk about it? Use the systematic problem-solving approach in the following situations: CLIENT: Someday, but not now. HELPER: So the problem seems to be that your son doesn’t have any friends his own age. Is that right? The client requests help in solving a problem. The client requests help in choosing solutions to a problem. The client requests help in taking action on a selected plan. CLIENT: Yes. HELPER: Kay, let’s look at all the ways we can think of to help you get your son more involved with children his own age. Most people find it useful to think of as many alternatives as they can before making a decision. Here is an example of a counselor helping a client solve a problem. HELPER: What seems to be the problem, Kay? CLIENT: Okay. 86 Reading C HELPER: What ideas do you have? I’m going to write them all down so we don’t forget any. HELPER: How about talking with the school psychologist? She might have experience with this kind of problem. I’ll add it to the list. Kay, let’s look at each one and think what might happen if you were to do it. What do you think would happen if you talked to your son’s teacher again? CLIENT: Okay. I’ve been thinking about going in and talking to his teacher again. I’ve talked to him once, but it was a long time ago. It didn’t do any good then, but it might be better if I talked with him again. CLIENT: Probably nothing. HELPER: I see. HELPER: That’s an idea. CLIENT: He’s pretty strict with his students, and doesn’t have much sympathy for children who are having problems. Last time I talked to him, he said children’s problems are all caused by their parents. Maybe that’s true, but it didn’t help me out at all. CLIENT: I’ve already tried talking to my son about it, but he doesn’t want to talk about it at all. HELPER: So, Kay, another alternative might be trying to talk to him again? CLIENT: Anything is worth a try at this point. HELPER: I can understand that. CLIENT: Anyway, I don’t expect it to help, but maybe talking to him again would be worth a try. HELPER: Can you think of any other things you can do? CLIENT: Um… HELPER: One thing that might come out of it is letting him know you are really concerned about your son. That might make him listen to you more. HELPER: Have you thought about your husband, son, and yourself talking to a professional counselor about the problem? CLIENT: Never thought of that. Could be, but with him, I don’t know. CLIENT: No. That might be a good idea. I hadn’t thought of that. HELPER: So, Kay, how would you rate this idea? Excellent? Fair? Poor? HELPER: Let’s see. What else could you do? CLIENT: I could always just keep waiting and hoping it’s only a phase. That’s really what I’ve been doing, you know. CLIENT: Oh, I’d say fair. HELPER: Okay. What about talking to your son? How does that alternative sound? HELPER: Uh-huh. Can you think of any other things to do? CLIENT: That’s the worst on the list. Believe me, I’ve tried. He won’t talk, gets very angry when I bring the subject up, and we usually end up yelling at each other, which defeats the whole purpose. CLIENT: No. HELPER: (Pauses) Let me think. (Pauses) I can’t either. Kay, let me read back the alternatives we’ve thought of. You could try talking to your son’s teacher again. You could talk to you son. We thought of your husband, son, and you talking to a professional counselor. We also thought of just waiting and hoping the problem passes with time. Can you think of any more? HELPER: Doesn’t sound like you feel that’s a promising avenue to take. CLIENT: No, I don’t. HELPER: How would you rate it, excellent, fair, or poor? CLIENT: Oh, rate that one as poor. HELPER: What might happen if you all went to a professional counselor for help? CLIENT: No. The list sounds pretty complete. 87 Study Guide 1: Counselling and the counselling process CLIENT: I think it would do us all good. CLIENT: I know. It might help, but I’d rather get professional help outside of the school. HELPER: I see. CLIENT: I know it would do me good. HELPER: I keep noticing that you favor the professional counselor. HELPER: Uh-huh. CLIENT: I like that idea. CLIENT: I am, and there’s another reason, too. My husband and I are in disagreement about what to do about our son. I think we could use the help of a counselor ourselves. HELPER: What are you imagining would come from it? CLIENT: Well, we could get everything out in the open. My son won’t talk to me, but maybe he’d talk to a counselor about what’s been going on with him. HELPER: You sound pretty positive about things working out alright. CLIENT: Talking about them now is making me realize that I really am. I think my husband and I need to get some things squared away between ourselves, and I know that we’ll be able to do that. HELPER: Uh-huh. You sound more positive about this idea. CLIENT: I am. HELPER: Professional counseling may cost you something. HELPER: Where would you rate the school psychologist idea? CLIENT: It would be well worth it if it helped. CLIENT: Between excellent and fair. HELPER: Are there any other outcomes you can think of? HELPER: We also listed just waiting. How do you feel about that alternative? CLIENT: No. CLIENT: It’s out of the question. I can’t afford to wait anymore. HELPER: How would you rate this idea? HELPER: Here’s the list, Kay, and the way you rated each alternative. Which sounds the best? CLIENT: Excellent. HELPER: What about talking to the school psychologist? CLIENT: The professional counselor. I like that idea, and I think it’s going to help. CLIENT: Not as good. It could help, but then again, if my son found out, he’d be mad because he’s told me to leave him alone about it. HELPER: Sounds good, huh? CLIENT: Yes. HELPER: What are your feelings about that, Kay? HELPER: Sounds good to me, too. Do you have any further questions about how to find a counselor? CLIENT: Well, he doesn’t talk that often, so when he says something, I try to respect it. I’d hate to embarrass him in front of his peers. That could end up making him even more withdrawn and alone. You know how kids are. CLIENT: No. I’m sure my friends can recommend someone. HELPER: Please let me know how things work out. CLIENT: I will. This has been so helpful. Thank you. HELPER: Yeah, I do. One possible advantage, though, is that you might get some ideas from the school psychologist because she may have been able to observe your son in school. 88 Reading C We recommend a series of activities to help a client solve a problem. Each is described below; all fourteen are listed in the summary at the end of this chapter. Writing the problem down can serve several purposes. For one, it will allow you to list the alternatives suggested during the problemsolving process. This will help you remember all the alternatives mentioned and will help you sum up when closing the helping session. It will also be useful if the client requests further help. The written information will refresh your memory of an earlier meeting with the client. Request a Problem Statement You should request a problem statement by asking an open-ended question. The question should be followed by a pause of at least five seconds. Use two sheets of paper with carbon paper between them. This way you can file one copy for yourself and you can give one copy to the client. One way to set up the paper is in a problem-solving worksheet (see Figure 3) It is sometimes the case that the client will state the problem without the counselor requesting a problem statement. Some clients begin speaking about their problems without any specific request from the counselor. If this occurs, go to the next step, which is to define the problem. Here are two ways to request a problem statement and define the problem: Define the Problem Example 1 HELPER: What seems to be the problem? You should repeat the problem statement either in your own words or in the client’s. Use a close-ended question to make sure of your understanding of the problem. Wait in silence for the client to confirm or dispute your definition of the problem. If the client partially confirms or disputes your definition of the problem, ask the client for another problem statement, and attempt once again to define the problem. When the client confirms your definition, you may want to write the problem down on a sheet of paper. CLIENT: I’m totally out of money because I haven’t been able to find a job in the past five months. HELPER: So it seems the problem is that you need a job soon or some money to hold you over until you can find one. Is that right? CLIENT: Yep, that’s it. Example 2 HELPER: How would you describe the problem? Waiting for a confirmation is a way to make sure you and the client are talking about the same thing. It also gives your client an opportunity to add or clarify something so that you can have a fuller picture of the problem situation. CLIENT: My father is getting pretty old. He forgets things and is barely able to take care of himself anymore. He is living by Figure 3. Headings for a Problem-Solving Worksheet Client’s Name: Date: Counselor’s Name: Problem: Alternatives: 89 Study Guide 1: Counselling and the counselling process himself, and that worries me. I don’t know what to do. thinks of, regardless of how they may sound at first. It can be helpful to tell the client that by looking at the possible positive and negative outcomes of each alternative, he or she should be able to make the best decision. You may also want to explain why you are writing down the alternatives mentioned. HELPER: Let me make sure I’m clear. The problem is that your father is getting old and can’t take care of himself anymore. Is that correct? CLIENT: Yes, and I don’t think he can come live with me. State the Usefulness of the Problem-Solving Process Here is one way to request a problem statement and define the problem after a client rejects the helper’s problem statement. Notice how the helper attempts to define the problem again: Example HELPER: What seems to be the problem? After explaining the problem-solving process, you should tell the client that the process will be useful. You might also want to say that upon completion of the problem-solving process, the client may be able to make future decisions on his or her own using this systematic process. CLIENT: I’m totally out of money because I haven’t been able to find a job in the past five months. Examples of how to explain the problemsolving process and its usefulness to a client are: HELPER: I imagine that must be creating a problem between you and your wife. “We’re going to figure out as many ways of solving your problem as we can. The best way to make a good decision is to look at each possible solution and figure out its consequences. Let’s think of all the solutions we can, regardless of whether they sound good or bad. I’m going to write everything down so we don’t forget any of them. It should be a very useful process for helping you solve your problem.” “We’re going to use a systematic approach to problem solving. It involves thinking of all possible alternatives for solving your problem, regardless of how good or bad they sound. I’ll write them down. We’ll look at the pros and cons of each, and you should be able to decide on a way to solve your problem. By going through this process with me, it may make it easier to solve a future problem on your own.” CLIENT: No, my wife is very understanding. HELPER: What is the problem then? CLIENT: I’m getting very depressed from having nothing to do. I need to find a job. HELPER: So, you’re needing some help in finding a job, is that right? CLIENT: Yeah, that’s right. The outcome is a list of one or more problem statements. Write only one statement per sheet of paper. Clients may need help with more than one problem. We recommend that you assist a client in solving one problem at a time. Explain Process the Problem-Solving You should explain to the client how you will be helping to solve his or her problem. Provide a rationale for using this process. You might say that you and the client will be thinking of possible ways to solve the problem. You might want to encourage the client to tell you any alternatives he or she An explanation of the problem-solving process will give a client an overview of what will follow. It can help make a client feel more relaxed. It also can make the problem-solving process go faster because the client knows 90 Reading C beforehand what you will do and what will be expected. Examples of how to introduce this method are: Stating the usefulness of the problem-solving process can give encouragement to a client who may feel that there is no solution to his or her problem. Identify Alternative Solutions “Let’s see what alternatives we can think of. What ideas do you have?” “Let’s list all of the possibilities to solving the problem that we can. What are some you can think of?” One cannot, at this point, determine which alternative will turn out to be best for the client. You must encourage the client to mention any idea at all, regardless of how unlikely it may sound. This is the time to think of as many solutions as possible. Sometimes the most farfetched ideas turn out to be the best. A client will often feel much better knowing that many possible solutions exist. Don’t make negative or positive evaluations of any alternative at this point. Your neutrality may encourage the client to feel freer to voice any idea. In reality, a counselor does not know the consequences an alternative may have in a client’s life. If you were to offer your opinion of an alternative at this point, a client might begin to feel that you are pushing your ideas without fully understanding his or her situation. To identify alternative solutions, first ask a client to tell you all the possible solutions he or she can think of to the problem. Write these down. No possible solutions should be excluded. Second, ask open-ended questions to encourage the client to consider any solutions that you suggest. You may want to use the Problem Solving Index in Part III of this book for additional ideas. You might introduce your ideas with openended phrases, such as, “Have you thought about…?” or “What about…?” It is best not to suggest your alternatives by saying, “You should do…,” or “You ought to…” Effective helpers neither argue for their own suggestions nor evaluate negatively or positively those of the client. Take special care not to play with you pen during the helping session, lest you seem bored or impatient. Also, take care not to talk as you write, because it is difficult to concentrate on either when you do both together. Write down all the alternatives that both of you mention. Figure 4 is an example of a partially completed problem-solving worksheet. Figure 4. Partially Completed Problem-Solving Worksheet Client’s Name: Susan Singer Date: February 26, 1980 Counselor’s Name: Kathy Langer Problem: Gets lonely Alternatives: 1. Join club in school to meet new people 2. Join church youth group to meet new people 3. Talk to new person in class 4. Talk to professional counselor 5. Join sports team 6. Find satisfying hobby you can do by yourself 7. Make plans to do things with friends 8. Do things with your family 91 Study Guide 1: Counselling and the counselling process PART II: Summarize Mentioned the Analyze the Consequences Alternative Alternatives You should make a summarizing statement. Include all the alternatives you and the client have mentioned. You can do this by reading the list of alternatives you have written down. Remember to ask the client if there are any other alternatives not yet mentioned. You should introduce the next phase of the problem-solving process by telling the client that analyzing the consequences of each alternative will help him or her to make the best decision. Ask the client to state all possible outcomes for each listed alternative. You should also state any consequence you can think of, even if it probably doesn’t apply to the client’s situation. You may want to use the Index in Part III for additional ideas. No consequence should be excluded. Here is an example of a counselor summarizing the alternatives identified: Possible of Each “Let’s go over the alternatives we’ve thought of. You can join clubs in school or join your church youth group to meet new people, talk to a new person in class, talk to a professional counselor for more help, join a sports team, find a hobby you’d like to do by yourself, make plans to do things with friends, or do things with your family. Can you think of any more?” The analysis of possible consequences should include a consideration of the following things: 1. benefits gained for the client and others, 2. problems caused for the client and others, 3. feelings that could be aroused for the client and others, 4. availability of the alternative, 5. any entrance requirements; that is conditions that may have to precede the alternative. Turn the Worksheet toward the Client Turn the paper on which the alternatives are listed toward the client so that he or she may easily read through the list. You might want to ask if there are any other solutions that should be added to the list. It can be helpful to ask the client a specific question about each of these five considerations for each alternative before considering the next one. As with all summarizing statements, summarizing the alternatives identified provides an opportunity for the client or helper to make additional comments. It signals the client that you both are ready to move on to the next phase of the process. Some examples of how to ask a client to consider the consequences of each alternative are as follows: People often find it useful to read the list because it makes it easier to remember the alternatives mentioned. Sharing the list with the client can help the client remain active in the problem-solving process. Remember good counselors help a client solve a problem; they don’t solve the problem for a client. “What do you think would happen if you choose this one?” “What outcomes would be likely if you decided to do this?” “How do you feel about this idea?” “What are the advantages of this one? What are the disadvantages?” Since the consequences of any solution affect the client’s level of satisfaction, the careful analysis of each alternative is an important aspect of problem solving. 92 Reading C Note: Clients often express many feelings (both verbally and nonverbally) while analyzing the positive and negative consequences of each alternative. Try to make reflecting statements when you observe these feelings. CLIENT: The main one is that I’ll have to find some way to support myself if I give up my job to go back to school. HELPER: Yep. What other disadvantages might there be? CLIENT: Well, what happens if I’ve forgotten how to study? Here is an example of a client and helper analyzing the consequences of one alternative. Note how the helper reflects the client’s feelings. Also note the open-ended style that introduces the consequences the helper mentions. HELPER: You seem to be concerned about that. CLIENT: I am. It’s probably why I’ve never enrolled in school again. HELPER: (Makes nonverbal encouragements) HELPER: Let’s look at the advantages and disadvantages of each alternative. That should help you make the best decision about what to do. The first one is going back to school. How do you think you might benefit from doing that? CLIENT: I’ve had many people tell me not to worry about it, but I guess I do. HELPER: It sounds like it’s the main reason you have for not going back to school. CLIENT: I guess it’s really the only reason. CLIENT: Well, I could probably get a better job after I finish. HELPER: Are there other disadvantages to going back to school except perhaps having difficulty with the studying? HELPER: Uh-huh. What other advantages might there be? CLIENT: Not really. CLIENT: I know I would enjoy being back in school. HELPER: Have you considered whether or not you can get into the program? HELPER: You sound like that’s an exciting thought. CLIENT: Ah, thanks for reminding me about that. I’d really like to return to school, and sometimes I forget that I still have to be accepted. CLIENT: It is. I’ve often thought about wanting to return to school. I liked being in school. HELPER: (Nods head) What else do you think might happen if you go back to school? HELPER: What other benefits might there be? CLIENT: Really, nothing bad. CLIENT: Just mostly being able to get a better job. HELPER: I can’t think of anything else. HELPER: Have you thought about the fact that going back to school may give you a way to meet a whole new group of people? Carefully analyzing each alternative in this way will help a client choose the best plan of action. Questioning a client about the advantages, disadvantages, availability, and any entrance requirements helps to ensure that a chosen alternative is feasible and satisfactory. Making comments or asking questions about a client’s feelings toward an alternative helps to bring into the open any concerns he or she may have toward a possible course of action. You will then be in a better position to help the client deal with his or her concerns. CLIENT: That’s true. I think that’s partly why I’ve been wanting to go back to school. HELPER: Can you think of any more benefits of going back to school? CLIENT: No. HELPER: I can’t either. What problems might be caused by it? 93 Study Guide 1: Counselling and the counselling process Rate Each Alternative alternatives on the basis of the ratings and your discussion. After analyzing the consequences of one alternative, ask a question to determine how satisfactory the client finds that alternative. Use a rating scale, such as excellent, fair, or poor, and write down the client’s rating next to each alternative. An example of asking the client to select the best alternative or alternatives is as follows: Two examples of how to ask a client to rate his or her satisfaction with an alternative are as follows: “Here is the list of alternatives. Based on your ratings and all we’ve talked about, which one sound best?” Determine Client’s Satisfaction with Choice “If you were to label this alternative, what would you call it: excellent, fair, or poor?” “How good does this alternative sound? Would you rate it excellent, fair or poor?” You should ask an open-ended question to determine if the client is satisfied with his or her selected alternative(s). If the Client is Satisfied with the Choice, State Your Support for the Decision Writing the rating next to the alternative on the counselor’s list will allow a client and counselor to look at the list and see how each alternative is rated in comparison with the others. This will make it easier for a client to see which alternatives he or she favors. You should tell the client you think the decision is a good one. Ask if Help is Needed to Take Action Select the Best Alternative After every alternative is analyzed and rated, give the list of rated alternatives to the client. Ask the client to select the best alternative or You should ask a close-ended question to determine if the client knows how to carry out the chosen alternative(s). Figure 5. Completed Problem-Solving Worksheet Client’s Name: Susan Singer Date: Counselor’s Name: Problem: Gets lonely Alternatives: 1. Join club in school to meet new people 2. Join church youth group to meet new people 3. Talk to new person in class 4. Talk to professional counselor 5. Join sports team Excellent X Fair Poor X X X X 6. Find satisfying hobby you can do by yourself 7. Make plans to do things with friends 8. Do things with your family February 26, 1980 Kathy Langer X X X 94 Reading C When the client has said he or she is satisfied with the choice, you may follow this example of stating your support for the decision and of asking if help is needed to take action: CLIENT: I don’t think so at this time. HELPER: So, it sounds like you think that calling a lawyer is the next thing to do, and then you will think about where to live. Anything else? “Carol, you decided that a trial separation from your husband would be the best idea. That sounds like a good idea to me, too. Do you have any questions about how to arrange for the separation?” CLIENT: No. That’s enough. If the Client Is Not Satisfied with the Choice, Try to Identify More Alternatives If It Is Needed, Provide Help in Taking Action You can do this by asking the client if he or she can make any other suggestions. Analyze the consequences of each of these new alternatives, and ask the client to rate each one. This can be done by suggesting ways of taking action. Ask the client if he or she can think of any others. You may want to write the suggestions down. Make a summarizing statement of the ideas mentioned, and ask a closed-ended question to determine the client’s satisfaction with the choice. Select the Best Alternative Give the complete list of rated alternatives to the client, and ask him or her to select the best one. Here is an example of asking if help is needed in taking action and in providing that help: When the client chooses an alternative, the counselor should then ask if help is needed to take action and, if it is, provide help. HELPER: Carol, you decided that trial separation from your husband would be the best idea. That sounds like a good idea to me, too. Do you have any questions about how to arrange it? Note: There may be times when a client chooses an alternative solution that is incompatible with the values of the helper, for example, using violence or illegal or immoral acts to solve a problem. If this occurs, you need not state support for the client’s decision nor provide help in taking action. If the client does threaten to do something illegal, you should consult your supervisor or, if you have no supervisor, a municipal agency head or the police. CLIENT: Yes. How do I go about doing it? HELPER: Let’s see what ways we can think of. How about calling your family lawyer and finding out what legal issues are involved? CLIENT: That’s a good idea. I think I’ll call my friend and use her lawyer, though. HELPER: What other concerns do you have? CLIENT: I guess I have to think about where I will live? The problem-solving process outlined above is followed for one problem at a time. If a client has identified more than one problem, repeat all of the activities for each problem. HELPER: Do you need help finding a place to live? Summary CLIENT: Gee, thanks. I think I can take care of that. In summary, the steps in problem-solving are as follows: HELPER: Are there other things you need help with? 1. Request a problem statement. 2. Define the problem. 95 Study Guide 1: Counselling and the counselling process 3. Explain the problem-solving process. 4. State the usefulness of the problemsolving process. 5. Identify alternative solutions. 6. Summarize the alternative identified. 7. Turn the list over to the client. 8. Analyze the possible consequences for each alternative. 9. Rate each alternative. 10. Select the best alternative. 11. Determine client’s satisfaction with choice. If the client is satisfied with the choice: 12. State your support for the decision. 13. Ask if help is needed to take action. 14. Provide help in action if needed. If the client is not satisfied with the choice: 12. Try to identify more alternatives. 13. Select the best alternative. 14. Ask if help is needed to take action. 15. Provide help in taking action if needed. 96 97 Study Guide 1: Counselling and the counselling process 98 Reading D Direct Social Work Practice: Theory and Skills (9th ed.) Dean H. Hepworth, Ronald H. Rooney, Glenda Dewberry-Rooney, and Kimberly Strom-Gottfried Brooks/Cole Belmont, CA, 2013 PGS 47– 50 99 Study Guide 1: Counselling and the counselling process Establishing Rapport people, especially those who have difficulty confiding in others. Before starting to explore client’s difficulties, it is important to establish rapport. Rapport with clients fosters open and free communication, which is the hallmark of effective interviews. Achieving rapport enables clients to gain trust in the helpful intent and goodwill of the social worker, such that they will be willing to risk revealing personal and sometimes painful feelings and information. Some clients readily achieve trust and confidence in a social worker, particularly when they have the capacity to form relationships easily. Voluntary clients often ask, “Who am I and why am I in this situation?”; involuntary clients have less reason to be initially trusting and ask, “Who are you and when will you leave?” (R. H. Rooney, 2009). Cultural factors and language differences compound potential barriers to rapport even further. For example, some Asian Americans and persons of other ethnic groups who retain strong ties to cultural traditions have been conditioned not to discuss personal or family problems with outsiders. Revealing problems to others may be perceived as a reflection of personal inadequacy and as a stigma upon the entire family. The resultant fear of shame may impede the development of rapport with clients from this ethnic group (Kumabe, Nishida, & Hepworth, 1985; Lum, 1996; Tsui & Schultz, 1985). Some African Americans, Native Americans, and Latinos may also experience difficulty in developing rapport because of distrust that derives from a history of being exploited or discriminated against by other ethnic groups (Longres, 1991; Proctor & Davis, 1994). Establishing rapport begins by greeting the client(s) warmly and introducing yourself. If the client system is a family, you should introduce yourself to each family member. In making introductions and addressing clients, it is important to extend the courtesy of asking clients how they prefer to be addressed; doing so conveys your respect and desire to use the title they prefer. Although some clients prefer the informality involved in using first names, social workers should be discreet in using first-name introductions with all clients because of their diverse ethnic and social backgrounds. For example, some adult African Americans and members of other groups may interpret being addressed by their first name as indicative of a lack of respect (Edwards, 1982; McNeely & Badami, 1984). Children may be unfamiliar with having conversational exchanges with unfamiliar adults (Lamb & Brown, 2006). For example, their exchanges with teachers may be primarily directive or a test of their knowledge. Asking them to describe events or family situations may be a new experience for them, and they may look for cues from the accompanying adult about how to proceed. Open-ended questions are advised to avoid providing leading questions. Clients’ difficulties in communicating openly tend to be exacerbated when their problems involved allegations of socially unacceptable behavior, such as child abuse, moral infractions, or criminal behaviour. In groups, the pain is further compounded by having to expose one’s difficulties to other group members, especially in early sessions when the reactions of other members represent the threat of the unknown. With many clients, social workers must surmount formidable barriers before establishing rapport. Bear in mind that the majority of clients have had little or no experience with social work agencies and enter initial interviews or group sessions with uncertainty and apprehension. Many did not seek help initially; they may view having to seek assistance with their problems as evidence of failure, weakness, or inadequacy. Moreover, revealing personal problems is embarrassing and even humiliating for some One means of fostering rapport with clients is to employ a “warm-up” period. This is particularly important with some ethnic minority clients for whom such openings are 100 Reading D cultural norm, including Native Americans, persons with strong roots in the cultures of Asia and the Pacific Basin, and Latinos. Aguilar (1972), for example, has stressed the importance of warm-up periods in work with Mexican Americans. Many Native Hawaiians and Samoans also expect to begin new contacts with outside persons by engaging in “talk story,” which involves warm, informal, and light personal conversation similar to that described by Aguilar. To plunge into a discussion of serious problems without a period of talk story would be regarded by members of these cultural groups as rude and intrusive. Social workers who neglect to engage in a warm-up period are likely to encounter passive-resistant behavior from members of these cultural groups. A warm-up period and a generally slower tempo are also critically important with many Native American clients (Hull, 1982). Palmer and Pablo (1978) suggest that social workers who are most successful with Native Americans are low-key, nondirective individuals. Similarly, increased self-disclosure is reported by Hispanic practitioners as a useful part of developing rapport with Hispanic clients (Rosenthal-Gelman, 2004). and a brief discussion of a timely topic (unusual weather, a widely discussed local or national event, or a topic of known interest to the client) will adequately foster a climate conducive to exploring clients’ concerns. Most clients, in fact, expect to immediately plunge into discussion of their problems, and their anxiety level may grow if social workers delay getting to the business at hand (Ivanoff, Blythe, & Tripodi, 1994). This is particularly true with involuntary clients who did not seek the contact. With these clients, rapport often develops rapidly if social workers respond sensitively to their feelings and skillfully give direction to the process of exploration by sharing the circumstances of the referral, thereby, defusing the threat sensed by such clients. Tuning in to their feelings and explaining what they can expect in terms of their role and that of the social worker goes a long way toward reducing these tensions (see Chapter 5). Respect for clients is critical to establishing rapport and we stress the importance of respecting clients’ dignity and worth, uniqueness, capacities to solve problems, and other factors. An additional aspect of showing respect is demonstrating common courtesy. Being punctual, attending to the client’s comfort, listening attentively, remembering the client’s name, and assisting a client who has limited mobility coveys the message that the social worker values the client and esteems his or her dignity and worth. Courtesy should never be taken lightly. Warm-up periods are also important in establishing rapport with adolescents, many of whom are in a stage of emancipating themselves from adults. Consequently, they may be wary of social workers. This is especially true of individuals who are delinquent or are otherwise openly rebelling against authority. Moreover, adolescents who have had little or no experience with social workers have an extremely limited grasp of their roles. Many adolescents, at least initially, are involuntary clients and perceive social workers as adversaries, fearing that their role is to punish or to exercise power over them. The judgment of how much warm-up is necessary and how much is too much is a matter of art and experience with initially reluctant potential clients…. Verbal and nonverbal messages from social workers that convey understanding and acceptance of clients’ feelings and views also facilitate the developing of rapport. This does not mean agreeing with or condoning clients’ views or problems, but rather apprehending and affirming clients’ rights to have their own views, attitudes, and feelings. Attentiveness to feelings and empathic responses to these feelings convey understanding that clients readily discern. Empathic responses clearly convey the …With the majority of clients, a brief warmup period is usually sufficient. When the preceding barriers do not apply, introductions 101 Study Guide 1: Counselling and the counselling process message, “I am with you. I understand what you are saying and experiencing.” The “workhorse” of successful helping persons, empathic responding, is important not only in Phase I of the helping process but in subsequent phases as well. Mastery of this vital skill (discussed extensively in Chapter 5) requires consistent and sustained practice. types of responses and must eliminate them from their communication repertoires. Toward this end, Chapter 7 identifies various types of responses and interviewing patterns that inhibit communication and describes strategies for eliminating them… Beginning social workers often fear that they will forget something, freeze up or become tongue-tied, talk endlessly to reduce their anxiety, or fail to observe something crucial in the interview that will lead to dire consequences (Epstein and Brown, 2002). Practice interviews such as those presented in subsequent chapters will assist in reducing this fear. It also helps to be aware that referred clients need to know the circumstances of the referral and clarify choices, rights, and expectations before they are likely to establish rapport with the social worker. Authenticity, or genuineness, is yet another social worker quality that facilitates rapport. Being authentic during Phase I of the helping process means relating as a genuine person rather than assuming a contrived and sterile professional role. Authentic behavior by social workers also models openness, which encourages clients to reciprocate by lowering their defenses and relating more openly (Doster & Nesbitt, 1979). Encounters with authentic social workers also provide clients with a relationship experience that more closely approximates relationships in the real world than do relationships with people who conceal their real selves behind a professional facade. A moderate level of authenticity or genuineness during early interviews often fosters openness. At this level, the social worker is spontaneous and relates openly by being nondefensive and congruent. In other words, the social worker’s behavior and responses match her or his inner experiencing. Starting Where the Client Is Social work researchers have suggested that motivational congruence – that is, the fit between client motivation and what the social worker attempts to provide – is a major factor in explaining more successful findings in studies of social work effectiveness (Reid & Hanrahan, 1982). Starting with client motivation aids social workers in establishing and sustaining rapport and in maintaining psychological contact with clients. If, for example, a client appears to be in emotional distress at the beginning of the initial interview, the social worker might focus attention on the client’s distress before proceeding to explore the client’s problematic situation. An example of an appropriate focusing response would be, “I can sense that you are going through a difficult time. Could you tell me what that is like for you right now?” Discussion of the client’s emotions and related factors tend to reduce the distress, which might otherwise impede the process of exploration. Moreover, responding sensitively to clients’ emotions fosters rapport – clients begin to regard social workers as concerned, perceptive, and understanding persons. Being authentic also permits the constructive use of humor, as elaborated in Chapter 6. Relating with a moderate level of authenticity, however, precludes a high level of selfdisclosure. Rather, the focus is on the client, and the social worker reveals personal information or shares personal experiences judiciously. During the change-oriented phase of the helping process, however, social workers sometimes engage in self-disclosure when they believe that doing so may facilitate the growth of clients. Rapport is also enhanced by avoiding certain types of responses that block communication. To avoid hindering communication, social workers must be knowledgeable about such 102 Reading D Novice social workers sometimes have difficulty in starting where the client is because they worry that they will not present quickly and clearly the services of the agency, thus neglecting or delaying exploration of client concerns. Practice will allow them to relax and recognize that they can meet the expectations of their supervisors and others by focusing on client concerns while sharing content about the circumstances of referrals and their agency’s services. language, which could cause difficulty in understanding even commonplace expressions. Where there are language differences social workers must slow down the pace of communication and be especially sensitive to nonverbal indications that clients are confused. To avoid embarrassment, some clients who speak English as a second language sometimes indicate that they understand messages when, in fact, they are perplexed. Starting where the client is has critical significance when you are working with involuntary clients. Because these clients are often compelled by external sources to see a social worker, they frequently enter initial interviews with negative, hostile feelings. Social workers, therefore, should begin by eliciting these feelings and focusing on them until they have subsided. By responding empathically to negative feelings and conveying understanding and acceptance of them, skillful workers often succeed in neutralizing these feelings, which enhances clients’ receptivity to exploring their problem situations. For example, social workers can often reduce negative feelings by clarifying the choices available to the involuntary client. If social workers fail to deal with their clients’ negativism, they are likely to encounter persistent oppositional responses. These responses are frequently labeled as resistance, opposition to change, and lack of motivation. It is useful to reframe these responses by choosing not to interpret them with deficit labels, but rather replacing them with the expectations that these attitudes and behaviors are normal when something an individual values is threatened (Rooney, 2009). As children and adolescents are often referred because adults are concerned about their behavior, and they may therefore be particularly resistant, the practitioner can clarify that he or she wants to hear how things are going from the child’s or adolescent’s viewpoint. Language also poses a barrier with many ethnic minority and immigrant clients who may have limited grasp of the English 103 Study Guide 1: Counselling and the counselling process 104 Reading E Issues and Ethics in the Helping Professions (9th ed.) Gerald Corey, Marianne Schneider Corey, Cindy Corey and Patrick Callanan Cengage Learning Stamford, CT, 2015 PART I: PGS 69 – 74 PART II: PGS 75 – 77 105 Study Guide 1: Counselling and the counselling process PART I: CHAPTER 3: VALUES AND THE HELPING RELATIONSHIP Clarifying your values and their role in your work The ability of counselors to manage their personal values so that they do not contaminate the counseling process is referred to as bracketing. Counselors are expected to be able to set aside their personal beliefs and values when working with a wide range of clients. Many clients will have a worldview different from that of the counselors, and clients bring to us a host of problems. They may have felt rejected by others or suffered from discrimination. Clients should not be exposed to further discrimination by counselors who refuse to render services to them because of differing values. Introduction The question of values permeates the therapeutic process. In this chapter we ask you to think about your values and life experiences and the influence they will have on your work. We ask you to consider the possible impact of your values on your clients, the effect your clients’ values may have on you, and the possible conflicts that can arise if you and your clients have different values. We also hope to bring attention to the central role culture plays in determining the values we hold, both personally and professionally. In other ethics courses, students sometimes ask, “Can I put a values statement in my informed consent document that communicates the nature of my personal values so prospective clients can make an informed decision about whether to enter a professional relationship with me?” If you were to incorporate a personal values statement in your informed consent materials, what would you include? Would you identify specific areas you have difficulty maintaining objectivity about because of the values you hold? Would you include your position on any of the value areas we address in this chapter? Although perhaps well intentioned, such disclosures put the emphasis in the wrong place – on the counselor’s values. This can easily convey a judgmental attitude to clients about issues with which they may be struggling. Can therapists keep their values out of their counseling sessions? The belief that practitioners can be completely objective and value-free is no longer a dominant perspective in the field of psychology (Shiles, 2009). Levitt and Moorhead (2013) contend that values not only enter the counseling relationship but can significantly affect many facets of the relationship. Counselors need to understand how their own values can permeate their work with clients for good or ill, perhaps unconsciously. Although clinicians may not agree with the values of some clients, clinicians are expected to respect the rights of clients to hold their own views. By demonstrating a nonjudgmental attitude toward clients with different values, we can remain invested in the work our clients are doing. For example, a counselor can help a client who is deciding whether or not to leave a committed relationship by exploring the client’s motivations and the possible consequences of either decision, but pressuring the client to choose a particular outcome would be unethical. By honoring the client’s self-determination, we help to empower the client. Counselors may have the ability to work with a range of clients with diverse worldviews and values. Value exploration is at the heart of why many counselor education programs encourage or require personal therapy for counselors in training. Your personal therapy sessions provide an opportunity for you to examine your beliefs and values and to explore your motivations for wanting to share or impose your belief system. 106 Reading E In counseling, clients struggle to make changes in their lives. We question the underlying assumption that counselors have greater wisdom than their clients and can prescribe better ways of being happier. Unquestionably, psychoeducation is a part of counseling, and counselors do facilitate a process of helping clients gain a fuller understanding of their problems. However, the process of counseling is meant to help clients discover their own resources for dealing with problems rather than listening to advice from others. Counseling is a dialogue between therapist and client that is meant to further the client’s goals. Because your values can significantly affect your work with clients, you must clarify your assumptions, core beliefs and values, and the ways in which they influence the therapeutic process. If counselors have a strong commitment to values they rarely question, whether these values are conventional or unconventional, may they be inclined to promote these values at the expense of the clients’ exploration of their own attitudes and beliefs? If counselors rarely reflect on their own values, it is unlikely that they can provide a climate in which clients can examine their values. The following questions may help you to begin thinking about the role of your values in your work with clients: What are some potential advantages and disadvantages in having similar life experiences with your client? In what ways are challenging clients to examine their values different from imposing values on them? Do you think it is ever justified to influence a client’s set of values? If so, when and in what circumstance? In what ways could discussing your values with clients unduly influence the decisions they are making? Can you interact honestly with your clients without making value judgments? If you were convinced that your client was making a self-destructive decision, would you express your concerns, and if so, how would you do it? Do you think therapists are responsible for informing clients about a variety of value options? How are you affected when your clients adopt your beliefs and values? Can you remain true to yourself and at the same time allow your clients the freedom to select their own values, even if they differ from yours? Is a referral ever justified on the basis of a conflict of values between counselor and client? If so, in what instances? Do you believe certain values are inherent in the therapeutic process? If so, what are these values? How does exposing your clients to your viewpoint differ from subtly influencing them to accept your values? In the following sections we examine some sample cases and issues to help you clarify what you value and how this might influence the goals of counseling and the interventions you make with your clients. As you read these examples, keep the following questions in mind: What is my position on this issue? Where did I develop my views? Am I open to being challenged by others? Under what circumstances would I disclose my values to my clients? Why? What are my reasons for wanting to reveal my values to a client? Do my actions respect the principle of clients’ self-determination that is consistent with their culture? The ethics of imposing your values on clients The imposition of values by the counselor is an ethical issue in counseling individuals, couples, families, and groups. Value imposition refers to counselors directly attempting to influence a client to adopt their counselors’ values, attitudes, beliefs, and behaviors. It is possible for mental health 107 Study Guide 1: Counselling and the counselling process practitioners to do this either actively or passively. For example, a key element in some addiction treatment programs is that clients accept that there is a power higher than themselves. Although clients are encouraged to define for themselves what this higher power is, some addiction counselors may be tempted to impose their own personal beliefs of what the higher power is, which raises ethical issues. Counselors are cautioned about this kind of value imposition in their professional work in this ACA (2005) standard: you to work with a client who has a different value system? Merely disagreeing with a client or not particularly liking what a client is proposing to do is not ethical grounds for a referral. When you recognize instances of such value conflicts, ask yourself this question: “Why is it necessary that there be congruence between my value system and that of my client?” Clients are in a vulnerable position and need understanding and support from a counselor rather than judgment. It can be burdensome for clients to be saddled with your disclosure of not being able to get beyond value differences. Clients may interpret this as a personal rejection and suffer harm as a result. Counseling is about working with clients within the framework of their value system. If you experience difficulties over conflicting personal values, the ethical course of action is to seek supervision and learn ways to effectively manage these differences. Personal Values. Counselors are aware of their own values, attitudes, beliefs, and behaviors and avoid imposing values that are inconsistent with counseling goals and respect for the diversity of clients, trainees, and research participants. (A.4.b) School counselors receive a similar caution in the ASCA (2010) code, which specifics that school counselors “respect students’ values, beliefs, and cultural background and do not impose the counselor’s personal values on students or their families” (A.1.c). Consider a referral only when you clearly lack the necessary skills to deal with the issues presented by the client. Do not try to convince yourself that you are working in a client’s best interest by referring to a person because of value conflicts. The counseling process is not about your personal values; it is about the values and needs of your clients. Your task is to help clients explore and clarify their beliefs and apply their values to solving their problems. In group work values imposition may come from both the leader and members in the group. The group leader should not shortcircuit members’ exploration of issues by providing answers. Some members may inappropriately respond by giving advice to another member. Value clashes often occur between members, and leaders have a responsibility to intervene so that no members can impose his or her values on others in the group. The group leader’s central function is to help members find answers that are congruent with their own values, and these answers will not be the same for all group members. Value conflicts may become apparent only after a client has been working with you for some time. Consider this scenario. You believe you would have difficulty counseling a woman who is considering an abortion. You have been counseling a woman for several months on other concerns, and one day she discloses that she is pregnant. She wants to explore all of her options because she is uncertain about what to do. Would you tell your client that you needed to refer her because of your values pertaining to abortion? Could such a referral be considered client abandonment? Would it be ethical for you to offer advice from your value position if she Value conflicts: to refer or not to refer Having a conflict of values does not require a referral; it is possible to work through such conflicts successfully. Before considering referral, explore your part of the difficulty through consultation or supervision. What barriers within you would make it difficult for 108 Reading E asks for your advice? What are the ethical and legal aspects of imposing your values on this client? If you cannot maintain objectivity regarding a certain value, this is your problem rather than the client’s, and your ethical responsibility is to seek supervision or consultation. assume that such practices are appropriate, reasonable, and acceptable. We tell our students who want to make a referral based on a value conflict to ask themselves these questions: What skills am I lacking in counseling a client struggling with a critical life decision? How can I determine what would ethically justify a referral? Discriminatory Referrals Students often wrestle with the question of when to refer a client: are their value differences too great, or does the student recognize that he or she does not have the necessary competence to work with the client? Insufficient training is sometimes a cover for the real reason – the counselor’s difficulty with the client’s values. PART II: Seeking Supervision Regarding Your Values It is not ethical to refer clients based solely on differences of values between the counselor and the client. Through supervision, counselors in training can learn that they do not have to renounce their own values, but they must avoid using their values to steer clients in a given direction or to make decisions for clients. It is our job to be invested in the process of a client’s decision making rather than directing the person toward outcomes that we deem as being “right” for them. Shiles (2009) notes that far too little has been written about situations in which referring a client is inappropriate, unethical, and may constitute an act of discrimination. Shiles asserts that inappropriate referrals have been made for clients with differing religious beliefs, sexual orientations, or cultural backgrounds. Counselors rationalize these referrals as a way to provide the client with the best services; however, such practices may be discriminatory. Shiles makes the following observations: Consider the following list of potential clients that follows and indicate whether you believe you could work with the client or would be challenged in doing so because of your countertransference or your own values. When would you need to consider supervision to stay neutral or to work effectively with the client? You may think it unlikely that you will encounter some of these situations, but you need to be prepared to deal with them if and when they do arise. Use this code in the following examples: Referrals have become common practice among mental health service providers at the expense of exploring other possibilities. Mental health providers may not be aware of the potential ethical violation in their referral decision because this topic is not highlighted in the professional literature. The overuse of client referral among mental health providers often involves discriminatory practices that are rationalized as ways to avoid harming the client and practicing beyond one’s level of competence. Discriminatory referrals have gone unnoticed and unchallenged far too often. The psychological community needs to critically examine why mental health practitioners may refer clients over value conflicts and why these practitioners A = I could work with this person. B = I would be personally challenged in working with this person. C = I would need to seek supervision to explore how my values or countertransference could affect my work with the person. ___ 1. A woman who is considering an abortion but wants help in making her decision ___ 2. A teenager who is having unsafe sex and sees no problem with this behavior 109 Study Guide 1: Counselling and the counselling process ___ 3. A person who shows little conscience development, who is strictly interested in his or her own advancement, and who uses others to achieve personal aims ___ 4. A gay or lesbian couple wanting to work on conflicts in their relationship ___ 5. A person who wants to leave his or her partner and children to pursue a sexual affair ___ 6. A person with fundamentalist religious beliefs ___ 7. A woman who says that if she could turn her life over to a higher power she would find peace ___ 8. A couple who comes for couples counseling while maintaining an extramarital affair ___ 9. An interracial couple coming for premarital counseling ___ 10. A high school student who thinks she may be bisexual and wants to explore her feelings around coming out ___ 11. A same-sex couple wanting to adopt a child ___ 12. An investment counselor who misleads clients to get a commission and who is not held accountable ___ 13. An interracial couple wanting to adopt a child and being faced with their respective parents’ opposition to the adoption ___ 14. A client from another culture who has values very different from yours (such as arranging the marriage of their children) ___ 15. A transgender person seeking support for coping with societal pressures and discrimination ___ 16. An undocumented worker seeking assistance in coping with severe discrimination by an employer ___ 17. A male client who brings his partner to you saying, “She is too Americanized and I want you to make her more willing to acknowledge my authority.” ___ 18. A woman who tells you that she molested several children in the past but is convinced she will not do so in the future ___ 19. A person with very strong political opinions that differ vastly from your own ___ 20. A heterosexual man who enjoys watching pornography with significantly younger boys Look back over the list, and pay particular attention to the items you marked “B” or “C.” What are some of the difficulties that come up for you in these situations? If you were seeking supervision, what questions would you ask? Do any of these situations have legal implications? 110 Reading F Practical Counselling and Helping Skills: Texts and Activities for the Lifeskills Counselling Model (6th ed.) Richard Nelson-Jones Sage Publications London, UK, 2014 PART I: PGS 137 – 139 PART II: PG 471 PART III: PGS 473 – 477 111 Study Guide 1: Counselling and the counselling process PART I: REFERRAL SKILLS or supervisors how best to assist certain clients. Occasions when one may refer the client’s problem rather than the client include: being the only counsellor available in the area; when clients state a clear preference for continuing working with you; and when clients are unlikely to follow through on referrals in any case. In any session, counselling trainees may face decisions about referring clients elsewhere. Even experienced counsellors have types of clients with whom they feel competent and comfortable and others where they feel less so. Lazarus states that an important counselling principle is to ‘Know your limitations and other clinicians’ strengths’ (Dryden, 1991: 30). He considers that referrals should be made where other counsellors have skills that the counsellor does not possess or more appropriate personal styles for particular clients. Important ethical issues surround referral: for instance, ensuring the best treatment for clients where other counsellors are more expert with specific problems, such as schizophrenia or post-traumatic stress disorders. The following are some skills for making referrals. Referral may not be an either/or matter. Sometimes you may continue working with clients but also refer to other counsellors and helping professionals. Alternatively, you may be the recipients of referrals from other helping professionals who continue to work with the clients concerned. I worked as a sessional counsellor in a leading career outplacement company where all my clients were referred by other professionals who continued seeing them for job search counselling. I acted as a ‘back-stop’ for clients whose problems were more severe or different from the normal clientele presenting for job search assistance. Sometimes clients were referred to gain additional knowledge about their problems. For example, clients with thought-blocking problems or sexual dysfunctions might be referred for medical checks. Depending on the outcome of these checks, you may gain relevant information to help determine whether or not to continue seeing them. On other occasions you can refer the clients’ problem rather than the client themselves to other counsellors and helping professionals. For example, you can discuss with colleagues 112 Know your strengths and limitations. Be realistic about the kinds of client with whom you work well and those with whom you are less skilled. Be realistic about your workload and set appropriate limits on it. Build a referral network. Get to know the resources available in the area so that you can make good referrals. Where possible, avoid referring ‘blind’ to someone whose competence is unknown. Furthermore, check whether another counsellor or helping professional has the time available to see the client. Provide appropriate information. Provide the client with relevant information about an agency or individual to whom they are referred: for instance, a contact person, their telephone number and professional address, their theoretical orientation, and the scale of fees charged, if any. If possible, refer early on. When you defer referrals longer than necessary, you waste clients’ and your own time. In addition, it is preferable to refer clients before emotional bonding takes place. Avoid unnecessary referrals. Sometimes it is better for clients to continue working with the counsellors that they have. Tune into anxieties and fears about seeing certain clients. You build confidence and skills by expanding the range of clients with whom you can work. However, wherever possible, you should ensure that you have appropriate supervision and support. Build a support network. A support network provides professional support when you want to refer clients’ problems rather than the clients themselves. Your support Reading F network is likely to overlap with their referral networks. than if supervised with others. Small group supervision also has some advantages: for example, it gives you exposure to a greater range of clients and enables you to develop skills of discussing and receiving feedback on your work from peers as well as from your supervisor. A combination of individual supervision and trainees participating in counselling-skills training groups has much to recommend it. Trainers can continue teaching assessment skills and different interventions in a training group. Furthermore, you can share your experiences of working with clients in ways that may be beneficial for all concerned. PART II: SUPERVISION Supervision literally means ‘overseeing’. Supervisors oversee the actions or work of others; in this context the focus is on how well counselling trainees use essential counselling and helping skills. Fortune and Watts state: ‘Counselling supervision is a space for practitioners to discuss their work with another professional with the purpose of providing support and consultation, with the aim of enhancing the counsellor’s work with clients’ (2000: 5). The British Psychological Society’s Division of Counselling Psychology (2006) emphasizes supervision as a process of collaborative and ongoing learning using evidence from research and practice. In addition, there are forms of consultative supervision. One format is that of one-to-one peer consultative supervision in which two counsellors provide support and supervision for one another by alternating the roles of supervisor and supervisee. In peer-group consultative supervision, three or more counsellors share the responsibility of providing one another with support and supervision. Trainee and trainee counsellors require training supervision prior to becoming accredited. However, you can also provide one another with consultative supervision. In reality, much consultative supervision takes place informally, with counsellors discussing clients and their reactions to them with trusted colleagues and those who have specialist knowledge. Carroll (1996) distinguishes between ‘training supervision’ and ‘consultative supervision’. Training supervision is part of the ongoing training of trainees both on courses and afterwards in their probationary period prior to becoming accredited as counsellors. Consultative supervision is an egalitarian arrangement between one or more qualified counsellors who meet together for the purpose of improving the practice of at least one of them. The major emphasis here is on training supervision rather than on consultative supervision, though the two emphases overlap. Counsellor training courses must prepare you and ensure that, in supervision, you are able to reflect on yourself and how you counsel. FUNCTIONS OF SUPERVISION The overriding goal of supervision is to aid trainees to think and communicate as effective counsellors and, in so doing, to develop the skills of being your own ‘internal’ supervisor. Box 30.1 lists some of the functions of supervision (Bond, 2010; Carroll, 1996; Fortune and Watts, 2000; Geldard and Geldard, 2005, King, 2008; McCann, 2011; Milne and James, 2000). I start the list by stressing the importance of thinking scientifically about your clients. Counsellors as practitioner-researchers search for evidence to support their work. Supervisors can encourage you as trainees to create hypotheses about what you do in counselling PART III: FORMATS FOR SUPERVISION Supervision can take place either one-to-one or with two or more trainees. Resources permitting, my preference, especially when trainees start seeing clients, is for individual supervision. Advantages of individual supervision include providing you with adequate time to be supervised thoroughly and the fact that you are more likely to discuss sensitive issues regarding clients and yourself 113 Study Guide 1: Counselling and the counselling process and then to monitor and evaluate the outcomes of your decisions. The process of supervision involves helping you, within a safe emotional climate, to question the adequacy of your performance and the thinking that precedes, accompanies and follows what you do. Such questioning attitude requires humility and a reasonable absence of defensiveness for you to be able to identify, explore and own genuine strengths and also to be honest about the skills you need to improve. Supervisors can also encourage you to examine the research and professional literature for suggestions as to what interventions to use with which clients, under what circumstances. Needless to say, such literature should be examined critically rather than unquestioningly and you should never attempt any intervention for which you are inadequately prepared. 11. 12. 13. 14. 15. 16. 17. be knowledgeable about the strengths of other counsellors. Helping trainees to understand the importance of developing good professional and personal support networks. Developing trainees’ ethical awareness and ethical decision-making skills. Developing trainees’ awareness and skills for dealing with diverse clients. Helping trainees to address tendencies to misperceive clients in order to meet their own needs. Teaching trainees to address insufficiently strong mind skills in relation to counselling and supervision. Developing trainees’ skills of using supervision time wisely. Providing trainees with knowledge of opportunities for continuing professional and personal development. Dealing with the formal administrative and evaluative aspects of supervision. BOX 30.1 SOME FUNCTIONS OF SUPERVISION 18. Overall goal: Developing trainees’ skills of being their internal supervisors. When you start counselling clients on placements and being supervised, you are at the exciting stage of putting into real-life practice the skills and learnings that you have acquired so far. This is the moment of truth towards which you and your trainers have been working. For many trainees, eager anticipation is tinged with apprehension that you are not good enough. Though some level of performance anxiety is realistic in beginning counsellors, those of your who have demanding and perfectionist rules create unhelpful levels of anxiety that can interfere with performance. Early on, supervisors may have to do some ‘hand holding’ as they help you to break the ice with real clients. Supervisors may need to assist you to examine insufficiently strong mind skills contributing to performance anxiety. Throughout supervision, supervisors should provide emotional support in ways that encourage self-reliance and honest self-appraisal rather than dependence and a need for supervisor approval. Functions include: 1. Teaching trainees to think scientifically about the counselling process. 2. Providing an external review of the counselling process. 3. Providing emotional support for trainees. 4. Being available in times of crisis. 5. Helping trainees to develop strong collaborative working relationships with clients. 6. Helping trainees to develop specific relationship, assessment and intervening skills. 7. Helping trainees to apply the lifeskills counselling model well and flexibly with clients. 8. Developing trainees’ skills of monitoring and evaluating their counselling practice. 9. Developing trainees’ ability to integrate research findings into their counselling practice. 10. Encouraging trainees to be realistic about their own limitations and strengths, and Supervisors can assist you to perform the joint tasks of providing good client services and 114 Reading F improving your essential counselling skills by helping you to explore how well you are conducting each stage and phase of the lifeskills counselling model. To some extent the supervision process parallels the counselling process, in that your supervisor should develop a good collaborative working relationship with you to provide a fertile context in which to monitor and improve your skills. In supervision, however, the main emphasis is on improving the mind skills and the communication skills required for effective counselling rather than on managing personal problems. professionals’ strengths. There is nothing shameful about referring clients to colleagues who have special areas of expertise – for instance, in pain management or in overcoming drug addiction. Supervision can help you realize the value of arranging in advance good support systems for such purposes as dealing with emergencies, medical considerations, clients with special problems, and your own levels of stress and burnout. Supervisors can also help trainees to understand the ethical dimensions of counselling, including issues connected with seeing clients in placement agencies and on counsellor training courses. Supervisors can address issues of diversity in supervisortrainee relationships and assist you in gaining awareness and skills for dealing with clients whose personal characteristics differ from your own. Helping trainees to offer clients high-quality counselling relationships is the primary task of supervision’s early stages. Supervisors who model good relationship skills are invaluable sources of learning. It is critically important that your supervisor assists you to develop a comfortable interviewing style that forms a sound base both for varying the nature of the counselling relationship (for instance by using skills such as questioning or challenging) and for using more technical skills and interventions. While supervision should have as its focus improving the trainees’ counselling skills, the dividing line between supervision and personal counselling is not clear-cut. As the Geldards write: ‘unless a counsellor owns and deals with their own issues, these issues are quite likely to interfere with the counselling process to the detriment of the client’ (Geldard and Geldard, 2005: 271-2). Supervision should back up counselling skills training groups in teaching you about the important aspects of practice. You may wrongly think you are not up to handling some of the clients you counsel on your placements. In many instances, placement agencies will screen clients before referring them to you. However, this is not always the case and Mearns (1997), based on experience at the University of Strathclyde’s free public Counselling Clinic, argues that resources spent on screening would be better diverted to supporting trainees as they work with challenging clients. You may bring past patterns of unhelpful thinking and communicating to both your counselling and your supervision relationships. Earlier I mentioned trainees whose demanding rules create their own performance anxiety, which in turn makes them less effective with clients. Assisting trainees to identify, challenge and restate such demanding rules might be perceived as performing aspects of personal counselling within the supervisory relationships. Similarly, if supervisors and trainees become aware of sexism or cultural prejudice, such issues require addressing in supervision as well as, possibly in personal counselling. Supervisors should help you to gain a realistic acknowledgement of your strengths and limitations. You can develop knowledge and confidence about when you may take on difficult clients, provided you have access to adequate support and supervision. Supervisors can also assist you to realize the importance of acknowledging other The supervision literature is full of references to counter-transference, the process by which counsellors and trainees distort how they 115 Study Guide 1: Counselling and the counselling process perceive and behave towards clients to meet their own needs. For instance, you may at varying levels of awareness be encouraging dependency, sexual interest or even distance in some clients. Effective supervision helps you to identify, explore and address such distortions, at least in so far as they affect your work with clients. Supervisors should also identify and address their own countertransference distortions towards their supervisees (Ladany et al., 2000). Supervisors who adopt the lifeskills counselling model should, as part of supervision, be assisting you to monitor the insufficiently strong mind skills that you may bring to and exhibit when counselling, and not just allow you to focus on the insufficiently strong mind and communication skills of clients. Some trainees require further personal counselling, a possibility that can also be explored within supervision. You need to learn how to get the most out of supervision, both when on a training course and afterwards. You need pointers to how you can improve your skills once supervision and the training course end. Supervision should help smooth out administrative aspects related to your seeing clients in placement agencies and provide appropriate feedback about your progress to your training course. 116 Reading G Personal Counseling Skills: An Integrative Approach Kathryn Geldard and David Geldard Charles C Thomas Springfield, IL, 2012 PGS 256 – 267 117 Study Guide 1: Counselling and the counselling process CONFIDENTIALITY AND OTHER ETHICAL ISSUES Many experienced counselors would agree with Woolfe and Dryden who in the Handbook of Counseling Psychology (2003) go so far as to say that promising total confidentiality is unethical. It is certainly true that confidentiality is compromised by the following: The first part of this chapter will be devoted exclusively to confidentiality, because it is one of the most important ethical issues for a counsellor. Other aspects of professional ethics will be considered in the second part of the chapter. Confidentiality Respecting client confidentiality is a fundamental requirement for keeping trust. For counseling to be maximally effective, the client must feel secure in the knowledge that what they tell the counselor is to be treated with a high degree of confidentiality. In an ideal world a client would be offered total confidentiality so that they would feel free to openly explore with the counselor the darkest recesses of their mind, and to discuss the most intimate details of their thoughts. As new counselors we naively believed that we could at all times give our clients an assurance that what was said in a counseling session was between them and us and would not be discussed with others. We very soon learned that this was an idealistic belief and found that in practice it is generally not possible, advisable or ethical to offer total confidentiality. the need to keep records; the requirements of the counselor’s own supervision; the need to protect others; working in conjunction with other professionals; participation in educational training programs, conferences, workshops and seminars; and cases where the law requires disclosure of information. The above list will now be discussed in detail. The Need to Keep Records As explained in Chapter 23, there are compelling reasons for keeping good records. Counselors who work in agencies frequently use computerized systems or centralized filing systems for such records. This may make it possible for other counselors and noncounseling staff such as receptionists and filing clerks to have access to confidential records. Some counselors omit to note certain categories of sensitive material on their record cards as a way of protecting clients. However, there are obvious consequences if this policy is adopted, as important information may be overlooked or forgotten during subsequent counseling sessions. Clearly, for the protection of clients, computerized records need to be protected by adequate security systems. Similarly, hard copy records should not be left lying around in places where they can be read by unauthorized people, and should be stored in lockable filing cabinets or in a secure filing room. As a counselor you may at times be troubled by some personal difficulties regarding confidentiality and may need to talk with your supervisor about these. Counselors are faced with a dilemma with regard to confidentiality. Unless we give out clients an assurance that what they tell us will be in confidence, they are unlikely to be open with us. However, there are limits to the level of confidentiality which we can offer and we need to be clear with clients about these limits. Most importantly, as a counselor you need to be aware of the limits to the confidentiality which you are offering. Requirements of the Counselor’s Own Supervision The requirements of professional supervision, as described in Chapter 26, demand that counselors be free to fully disclose client ABSOLUTE CONFIDENTIALITY IS OFTEN NOT POSSIBLE AND MAY BE UNETHICAL. 118 Reading G material relating to their supervisors. This is essential if the best possible service is to be provided, and is also necessary for the wellbeing of counselors themselves. Some counselors openly talk with their clients about the requirements of professional supervision and sometimes it can be reassuring for a client to know that their counselor is receiving supervision. It is also desirable for counselors to maintain good working relationships with other helping professionals. Sensible judgments need to be made about what information can be, and is disclosed, and what is withheld. It is important to try to avoid compromising the client’s trust in you as a counselor and to respect their rights as a person. WORKING IN COLLABORATION WITH OTHER PROFESSIONALS MAY BE ADVANTAGEOUS FOR THE CLIENT. COUNSELOR SUPERVISION IS ESSENTIAL AND IN THE CLIENT’S BEST INTERESTS. The Need to Protect Others Experienced counselors sometimes work with suicidal clients, dangerous clients, and with clients who have committed serious offenses against other people and may possibly repeat such behavior. Counselors have responsibilities to their clients and also to the community. Consequently, there may be instances where a counselor needs to divulge information to protect a client from selfharm, or to protect a third party. For example, if a counselor knows that their client possesses a gun and intends to kill someone, then it would be unethical and irresponsible if the person at risk, the police and/or the psychiatric authorities were not informed. Situations in which clients pose a risk of causing serious harm to themselves or others are particularly challenging for the practitioner. Consultation with a supervisor or experienced practitioner is strongly recommended, whenever this would not cause undue delay. In all cases, the aim should be to ensure for the client a good quality of care that is as respectful of the client’s capacity for self-determination and their trust as circumstances permit. If you believe that it is desirable that sensitive material be disclosed, then, you need to obtain the client’s permission first, unless there are unusual and compelling reasons for not doing so. Obtaining the client’s permission involves informing the client about what you wish to do and why. Thus, the client is able to give informed consent. This informed consent should be verified in writing so there can be no misunderstanding. Many agencies have a standard consent form which can be used when information is to be shared. This form is discussed with the client and then signed by both the client and the counselor. Where two or more members of a family require counseling help, family therapy may be useful. However, if family therapy is not available, or is considered inappropriate, then the helping professionals involved with members of the family are likely to achieve more for their clients if they consult with each other, have case conferences and work together as a team. However, if this is to occur the process needs to be made transparent to all family members involved, and their consent for sharing of information needs to be obtained. Working in Conjunction with Other Professionals Professionals such as psychiatrists, medical practitioners, psychologists, social workers, clergy and welfare workers frequently phone counselors to talk with them about mutual clients. It is sometimes in the interests of such clients for other professionals to be appropriately informed about their situations. Sometimes you may discover that a client of yours is also consulting another counseling professional. There is rarely justification for two counselors to work with the same client, and so after discussion with the client it is sensible to contact the other counselor to decide who will take over the case. However, as with most situations, there can be 119 Study Guide 1: Counselling and the counselling process exceptions. In a small number of cases, if good contact is maintained between two counselors, it may be possible for them both to remain involved provided that they maintain contact with each other and each set clear boundaries and goals for their work. unnecessarily divulged to others. It is quite unethical to talk about clients or client material to any person whatsoever, except in circumstances previously described in this chapter. What a client shares with you is personal property and must not be shared around, so if you do have a need to talk about a client or their issues then talk with your supervisor. Educational Training Programs, Conferences, Workshops and Seminars Another problem area regarding confidentiality concerns ongoing training, upgrading of skills and sharing of new techniques. Counselors need to grow and develop as people and as counselors. This can partly be done through personal supervision and partly through large group sharing at conferences, seminars, workshops and case conferences. Client material that is presented at such events can sometimes be disguised by changing names and other details, but often this is not possible, particularly when videorecordings of counseling sessions are used. Client material should never be used in this way without the prior written consent of the client. Moreover, there could be legal as well as ethical problems if consent is not obtained. WE ALL LIKE TO HAVE OUR PRIVACY RESPCTED. You will need to make your own decisions, in consultation with your supervisor, about how best to deal with the confidentiality issue. Our policy is to be up-front with clients and to explain the limits of confidentiality as they apply. For example, when we worked for an agency, that agency had a policy regarding confidentiality. Consequently, we needed to inform clients of that policy. As private practitioners, if we believe that it would be useful or sensible to divulge information for an ethically acceptable and professional reason, then we obtain the client’s informed consent, as we would if we were working for an agency. Where the Law Requires Disclosure of Information Remember that client confidentiality may be limited by legal intervention. Sometimes counselors are subpoenaed to give evidence in court and in such cases withholding information may be in contempt of court. Additionally, mandatory reporting is required in many jurisdictions by counselors with regard to issues such as child abuse. Professional ethics The issue of confidentiality has been discussed in some detail. However, there are many other ethical issues for counselors, and a new counselor needs to be informed of these. Many counselors belong to professional associations with codes of ethical conduct. These codes are readily available on request, and it is sensible for a new counselor to read through the relevant code for the relevant profession. Respecting the Client’s Right to Privacy Clearly, from the preceding discussion, there are many reasons why confidentiality in the counseling situation is limited. However, it is the counselor’s task to ensure that confidentiality is preserved as far as is sensibly, legally and ethically possible. Assure your clients that you will do this to the best of your ability, because they need to feel that whatever they share with you is protected information which will not be carelessly or Some important ethical issues are included in the list below, and these will be discussed in subsequent paragraphs: 120 respect for the client limits of the client-counselor relationship responsibility of the counselor counselor competence referral Reading G Limits of the Client-Counselor Relationship In all our relationships we set limits. Each of us has a boundary around us to preserve our identity as an individual. The strength of that boundary, and its nature, depends on who the relationship is with, and on the context of the relationship. The client-counselor relationship is a special type of relationship, established by the client for a particular purpose. The client enters into the relationship entrusting the counselor with their well-being and expecting that the counselor will, throughout the relationship, provide them with a safe environment in which they can work on their problems. termination of counseling legal obligations self promotion. Respect for the Client Regardless of who the client is, and regardless of their behavior, the client has come to you for help and deserves to be treated as a human being of worth. If you treasure your client, through feeling valued, they will be given the optimum conditions in which to maximize their potential as an individual. Most helping professionals agree that within each of us is the potential for good, and for that potential to be realized we need to feel O.K. about ourselves. Counselors therefore have a responsibility to help their clients to feel O.K. about themselves, and to increase their feelings of self-worth. As discussed previously, the client-counselor relationship is not an equal relationship and inevitably, whether the counselor wishes it or not, they are in a position of power and influence. They are often working with clients who are in highly emotional states and are consequently very vulnerable. The way in which a counselor relates to a client is uncharacteristic human behavior. A counselor devotes most of their energy to listening to and understanding the client, and so the person sees only a part of the counselor’s character. In these circumstances, a client may perceive a counselor as unrealistically caring and giving. The counselor’s power and the client’s biased perception combine to make the client very vulnerable to offers of friendship or closeness. GIVE THE CLIENT THE RESPECT YOU WOULD LIKE YOURSELF. If we try to impose our own moral values on clients, then we are likely to make them feel judged and to damage their self worth. Moreover, they are likely to reject us as counselors and to reject our values too. Paradoxically, if we are able to accept our clients, with whatever values they have, we are likely to find that as time passes they will move closer to us in their beliefs. This is inevitable because, as counselors, we are, whether we like it or not, models for our clients. We have a responsibility to be good models. In this regard, it can be useful to create opportunities for clients to give feedback about their experience of the counseling process. This will demonstrate respect for their views and their right to have some influence in the counseling relationship. The counselor is also vulnerable. In the counseling relationship, the client often shares their innermost secrets, and so inevitably there may develop a real closeness between the person and the counselor. Counselors learn to be empathic, and so they develop special relationships with their clients. If they are not careful they, too, become vulnerable to offers of closer relationships than are appropriate. Counsellors therefore need to be careful not to discount signposts that the counseling relationship is being compromised. We need to remember that the client’s interests must take precedence over the counselor’s during the counseling process. It is not ethical to use counseling sessions with people who seek help to work through our own issues. The correct time for working through our issues is in supervision sessions. 121 Study Guide 1: Counselling and the counselling process Clearly, the counselor has a responsibility to the client and needs to directly address the client’s request for counseling help. When a client comes to you for confidential help, you have an implied contract with them to give them that, unless you tell them something to the contrary. You cannot ethically fulfil the client’s needs if doing so would: COUNSELORS ARE VULNERABLE TOO! Unfortunately, it is almost always unhelpful and damaging to the client when the clientcounselor relationship is allowed to extend beyond the limits of the counseling situation. If such an extension occurs, the counselor’s ability to attend to the client’s needs is seriously diminished, and there may well be serious psychological consequences for the client. As a counselor, it may at times be hard to refuse invitations to get closer to your clients than the counselor situation allows. Remember that if you do not set appropriate boundaries you will be merely satisfying your own needs at the expense of the client. You will have abused your special position of trust as a professional, and you will have to live with that knowledge, and with any more serious consequences. When counselors breach appropriate boundaries they may damage or diminish the usefulness of the counseling process and reduce the possibility that the person seeking help will in the future seek further counseling help. Be aware of the danger signals if you notice that your relationship with a client is becoming too close, and bring the issue into the open by discussing it with your supervisor and with the client, if that is appropriate. involve working in opposition to the policies of the organization that employs you involve a breach of the law put other members of the community at risk be impossible for you personally. However, in these situations you need to be clear with your client about your own position, so that they understand the conditions under which they are talking to you. Counselors who are employed by an organization or an institution have a responsibility to that employing body. All the work they do within that organization or institution needs to fulfil the requirements of the employing body, and to fit in with the philosophical expectations of the employing body. For example, when we both worked for the Child and Youth Mental Health Service in Queensland, it was our responsibility to comply with the policies of the Queensland Department of Health. If we had not been able to do that, then we would have had an ethical responsibility to discuss the issue with our employers, or to resign. Counsellors need to exercise care if they touch a client in any way. Unwelcome touching is not only unethical, it may also be construed as sexual harassment. Responsibility of the Counselor Counselors frequently experience a sense of conflict between their responsibilities to the client, to the agency that employs them and to the community. You will at times need to make your own decisions about which of these responsibilities needs to take precedence, and in our view the decision is unlikely to always be the same. If you are in doubt about any particular decision, consult your supervisor. WE HAVE A RESPONSIBILITY TO THE CLIENT, OUR EMPLOYER, THE COMMUNITY, AND OURSELVES. Counselors have to be aware at all times of their responsibilities to the community at large. As discussed earlier, this raises problems with regard to confidentiality. Whenever a member of the community is at risk, or property is likely to be damaged, or other illegal actions are likely to occur, or have 122 Reading G occurred, then a counselor needs to make a decision regarding what action is needed. Often such decisions do not involve choosing between black and white, but rather between shades of grey, and sometimes counselors find it difficult to decide what is most appropriate in order to serve the needs of the client and community in the long term. At these times the sensible approach is for a counselor to talk through the ethical issues with their supervisor. It may sometimes be appropriate for a counselor to continue seeing a client while under intensive supervision, instead of referring. If this happens, then the counselor has a responsibility to inform the client. Often, referral is useful where people have special needs. For example, people with particular disabilities, people from other cultures and people who speak another language may benefit from referral to an agency (or professional) that can provide for their specific needs. Counselor Competence A counselor has a responsibility to ensure that they give the highest possible standard of service. This cannot be done without adequate training and supervision. All counselors need to attend to their own professional development and to have supervision from another counselor on a regular basis. Failure to do this is certain to result in the counselor’s own issues intruding into the counseling process, and this will be to the detriment of the client (see Chapter 26). When referring clients to others, it may be useful to contact the professional to whom the referral is being made, with the client’s permission, to ensure that the referral is acceptable and appropriate. Termination of Counseling Termination of counseling needs to be carried out sensitively and with appropriate timing (see Chapter 10). It is not ethical to terminate counseling at a point where the client still needs further help. If for some unavoidable reason (such as leaving the district) you need to do this, then it is incumbent upon you to make a suitable referral to another counselor who can continue to give the necessary support. A counselor also needs to be aware of the limits of their competence. We all have limits professionally and personally, and it is essential that as counselors we are able to recognize our limits and to be open with people who seek our help about those limits. The client has a right to know whether they are seeing someone who has, or does not have, the necessary abilities to give them the help they require. Legal Obligations Counselors, like all other professionals and every other member of the community, need to operate within the law. Therefore, as a counselor, you need to familiarize yourself with the relevant legal requirements for your profession. It is particularly important to know whether mandatory reporting of specific behaviors such as suspected child abuse is required. Referral When a client’s needs cannot be adequately met by a counselor, then that counselor has a responsibility to make an appropriate referral, in consultation with the client, to another suitable professional. However, it is not appropriate for a counselor to avoid all difficult and un-enjoyable work by excessively referring people to others. There is a responsibility on all counselors to carry a fair load, and to be sensible about referral decisions. Such decisions are best made in consultation with a supervisor. Self-Promotion Most professional associations for counselors have specific rules about advertising. There is clearly an ethical issue with regard to the way in which counselors describe themselves and their services. It is unethical for a counselor to make claims about themselves or their services which are inaccurate or cannot be 123 Study Guide 1: Counselling and the counselling process substantiated. Counselors who do this not only put the people who seek help at risk, but may also face the possibility of prosecution. Learning Summary For counseling to be most effective, a high degree of confidentiality is required. Confidentiality is limited by the need to keep records, professional supervision, the law, the protection of others, participation in training conferences and cooperation with other professionals. Professional ethics relate to issues such as respect for the client; limits to the relationship with the client; responsibility to the client, the employing agency and the community; competence; referral to others; termination of counseling; legal obligations; and self promotion. 124 125